Provider Demographics
NPI:1821365701
Name:POLICINICO STA CLARA
Entity type:Organization
Organization Name:POLICINICO STA CLARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAJAIRA DE JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ-FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-631-9903
Mailing Address - Street 1:2742 SW 8TH ST STE 19
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4635
Mailing Address - Country:US
Mailing Address - Phone:305-631-9903
Mailing Address - Fax:305-642-5333
Practice Address - Street 1:2742 SW 8TH ST STE 19
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4635
Practice Address - Country:US
Practice Address - Phone:305-631-9903
Practice Address - Fax:305-642-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty