Provider Demographics
NPI:1508577594
Name:CLINICA TODO SALUD - AIBONITO, LLC
Entity Type:Organization
Organization Name:CLINICA TODO SALUD - AIBONITO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGMENT
Authorized Official - Prefix:
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:939-231-0003
Mailing Address - Street 1:PO BOX 71114
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8014
Mailing Address - Country:US
Mailing Address - Phone:787-522-2482
Mailing Address - Fax:
Practice Address - Street 1:260 BOULEVARD DEL RIO
Practice Address - Street 2:TORRE 1 - BOULEVARD PLAZA OFFICE CENTER
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-522-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICA TODO SALUD - AIBONITO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty