Provider Demographics
NPI:1912656125
Name:CLINICA LAS MERCEDES, LLC
Entity Type:Organization
Organization Name:CLINICA LAS MERCEDES, LLC
Other - Org Name:LAS MERCEDES MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-233-6981
Mailing Address - Street 1:6355 NW 36TH ST BLDG STE 1100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7009
Mailing Address - Country:US
Mailing Address - Phone:786-233-6981
Mailing Address - Fax:786-322-2317
Practice Address - Street 1:450 SW 136TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-6073
Practice Address - Country:US
Practice Address - Phone:954-239-4818
Practice Address - Fax:954-751-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty