Provider Demographics
NPI:1679928675
Name:CLINICA LAS AMERICAS GUAYNABO, INC
Entity Type:Organization
Organization Name:CLINICA LAS AMERICAS GUAYNABO, INC
Other - Org Name:SALUS BAYAMON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-789-1996
Mailing Address - Street 1:PO BOX 7891 PMB 509
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7891
Mailing Address - Country:UM
Mailing Address - Phone:787-789-1919
Mailing Address - Fax:787-999-3071
Practice Address - Street 1:AVE. CASA LINDA 1 SUITE 101 CARR 177 LOS FILTROS
Practice Address - Street 2:CARR.177 KM.2.0 LOS FILTROS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:UM
Practice Address - Phone:787-789-1996
Practice Address - Fax:787-789-2180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICA LAS AMERICAS GUAYNABO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSOCIAL SECURITY PATRONAL