Provider Demographics
NPI:1689851040
Name:CLINICA YAGUEZ, INC.
Entity Type:Organization
Organization Name:CLINICA YAGUEZ, INC.
Other - Org Name:YAGUEZ COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:I
Authorized Official - Last Name:HUERTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-8444
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0698
Mailing Address - Country:US
Mailing Address - Phone:787-832-8444
Mailing Address - Fax:787-805-7440
Practice Address - Street 1:114 MCKINLEY
Practice Address - Street 2:PLAZA YAGUEZ SUITE 105
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-8444
Practice Address - Fax:787-805-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR837291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031576Medicare PIN