Provider Demographics
NPI:1407127244
Name:CLINICA ESPECIALIZADA INTERNACIONAL LAS TERRENAS
Entity Type:Organization
Organization Name:CLINICA ESPECIALIZADA INTERNACIONAL LAS TERRENAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-931-1717
Mailing Address - Street 1:255 ARAGON AVE, 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:407-931-1717
Mailing Address - Fax:407-931-2121
Practice Address - Street 1:CALLE DUARTE NO.26 LAS TERRENAS
Practice Address - Street 2:
Practice Address - City:SAMANA
Practice Address - State:LAS TERRENAS
Practice Address - Zip Code:NONE
Practice Address - Country:DO
Practice Address - Phone:407-931-1717
Practice Address - Fax:407-931-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital