Provider Demographics
NPI:1851826051
Name:CLINICA YAGUEZ, INC.
Entity Type:Organization
Organization Name:CLINICA YAGUEZ, INC.
Other - Org Name:PAVIA HEALTH CLINIC ANASCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:HUERTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-8445
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:787-832-8445
Mailing Address - Fax:787-805-2840
Practice Address - Street 1:CARR 402 KM 1.8
Practice Address - Street 2:ZONA INDUSTRIAL BO. MARIAS
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2017
Practice Address - Country:US
Practice Address - Phone:787-832-8445
Practice Address - Fax:787-805-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty