Provider Demographics
NPI:1205052131
Name:CLINICA ESPANOLA, INC.
Entity type:Organization
Organization Name:CLINICA ESPANOLA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:AGRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-0404
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0490
Mailing Address - Country:US
Mailing Address - Phone:787-832-0404
Mailing Address - Fax:787-832-2094
Practice Address - Street 1:106 KM 0.5 INTERIOR
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0000
Practice Address - Country:US
Practice Address - Phone:787-832-0404
Practice Address - Fax:787-832-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR46291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory