Provider Demographics
NPI:1598820540
Name:CLINICA ESPANOLA INC
Entity Type:Organization
Organization Name:CLINICA ESPANOLA INC
Other - Org Name:CLINICA ESPANOLA INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN PRES JUNTA DE GOBIERNO
Authorized Official - Prefix:
Authorized Official - First Name:EMIGOLIO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-0404
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BARRIO BALBOA SECTOR LA QUINTA CARR 106
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-0404
Practice Address - Fax:787-831-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13F-10433336C0003X
3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4025498OtherNCPDP PROVIDER IDENTIFICATION NUMBER