Provider Demographics
NPI:1417297540
Name:CLINICA DIVINO NINO JESUS INC
Entity Type:Organization
Organization Name:CLINICA DIVINO NINO JESUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:SR
Authorized Official - Phone:787-530-2694
Mailing Address - Street 1:3 CALLE LUIS M ALFARO
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720
Mailing Address - Country:US
Mailing Address - Phone:787-867-6448
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE LUIS M ALFARO
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-4467
Practice Address - Country:US
Practice Address - Phone:787-867-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13B4710261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health