Provider Demographics
NPI:1700574100
Name:CLINICAMENTE LLC
Entity Type:Organization
Organization Name:CLINICAMENTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TAINARI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-909-5359
Mailing Address - Street 1:PO BOX 10282
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0282
Mailing Address - Country:US
Mailing Address - Phone:787-909-5359
Mailing Address - Fax:
Practice Address - Street 1:CALLE SANTA CRUZ 68
Practice Address - Street 2:SUITE 606
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-909-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty