Provider Demographics
NPI:1790128080
Name:CLINICA EL BUEN SAMARITANO,INC.
Entity Type:Organization
Organization Name:CLINICA EL BUEN SAMARITANO,INC.
Other - Org Name:CLINICA EL BUEN SAMARITANO INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:MISS
Authorized Official - First Name:SAEZ
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:SANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:SECRETARIA
Authorized Official - Phone:787-857-0430
Mailing Address - Street 1:PMB 201 P. O.BOX 1999
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:787-857-0430
Mailing Address - Fax:787-857-0430
Practice Address - Street 1:CARR.152 KM 1.9 BO. QUEBRADILLAS
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-857-0430
Practice Address - Fax:787-857-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center