Provider Demographics
NPI:1154104511
Name:CLINICA SALUD PRIMARIA DE ARECIBO LLC
Entity type:Organization
Organization Name:CLINICA SALUD PRIMARIA DE ARECIBO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ OCANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-680-1211
Mailing Address - Street 1:171 URB LOS AIRES SERENOS
Mailing Address - Street 2:HELIO STREET
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-0000
Mailing Address - Country:US
Mailing Address - Phone:787-616-4736
Mailing Address - Fax:
Practice Address - Street 1:CARR. 2 KM 81.5 AVE. MIRAMAR
Practice Address - Street 2:1602 SUITE 2
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-680-1211
Practice Address - Fax:787-680-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1134634389Medicaid