Provider Demographics
NPI:1669898870
Name:CLINICA DE NINOS Y ADOLESCENTES CAGUAS
Entity type:Organization
Organization Name:CLINICA DE NINOS Y ADOLESCENTES CAGUAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSITRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:787-763-7575
Mailing Address - Street 1:EDIFICIO ANGORA
Mailing Address - Street 2:#162 CALLE GAUTIER BENITEZ
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-745-0630
Mailing Address - Fax:787-745-0630
Practice Address - Street 1:EDIFICIO ANGORA
Practice Address - Street 2:#162 CALLE GAUTIER BENITEZ
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-0630
Practice Address - Fax:787-745-0630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCTABA-0054261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9418Medicaid