LOS ANGELES MEDICAL CLINIC CORP

Provider Demographics

• NPI: 1912970351
• Name: LOS ANGELES MEDICAL CLINIC CORP
• Entity Type: Organization
• Organization Name: LOS ANGELES MEDICAL CLINIC CORP
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: MYRIAM
• Authorized Official - Last Name: SAEZ
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 787-721-0429
• Mailing Address - Street 1: 1400 CALLE SAN RAFAEL
• Mailing Address - Street 2: ESQ HIPODROMO SUITE 201
• Mailing Address - City: SAN JUAN
• Mailing Address - State: PR
• Mailing Address - Zip Code: 00909-2693
• Mailing Address - Country: US
• Mailing Address - Phone: 787-721-6626
• Mailing Address - Fax: 787-725-1287
• Practice Address - Street 1: 1400 CALLE SAN RAFAEL
• Practice Address - Street 2: ESQ HIPODROMO SUITE 201
• Practice Address - City: SANTURCE
• Practice Address - State: PR
• Practice Address - Zip Code: 00909-2644
• Practice Address - Country: US
• Practice Address - Phone: 787-721-6626
• Practice Address - Fax: 787-725-1287
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-02-08
• Last Update Date: 2018-08-17

Provider Licenses

State	License ID	Taxonomies
PR	70	103TC0700X
PR	1820	103TC0700X
PR	013924	207Q00000X
PR	11058	207Q00000X
PR	9251	207R00000X
PR	4847	207RC0000X
PR	8908	207RP1001X
PR	10561	207V00000X
PR	15909	208100000X
PR	16341	208D00000X
PR	16296	208D00000X
PR	624	225100000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208D00000X	Allopathic & Osteopathic Physicians	General Practice		Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RP1001X	Allopathic & Osteopathic Physicians	Internal Medicine	Pulmonary Disease	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
PR	4172	Other	PMC
PR	9090182	Other	HUMANA
PR	3153261	Other	UIA
PR	04486	Other	AMERICAN HEALTH INC
PR	9080048	Other	HUMANA
PR	3842	Other	AMERICAN HEALTH MEDICARE
PR	4965	Other	PALI
PR	=========	Other	MIDI
PR	=========	Other	APS
PR	4172	Other	PMC
PR	9080048	Other	HUMANA
PR	9090182	Other	HUMANA
PR	=========	Other	MMM
PR	=========	Other	FHCHS
PR	=========	Other	AUXILIO PLATINO
PR	=========	Other	MAPFRE
PR	04486	Other	AMERICAN HEALTH INC
PR	4965	Other	PALI
PR	=========	Other	MAPFRE EXCELL