Provider Demographics
NPI:1316753478
Name:CLINICA LAS MERCEDES, LLC
Entity type:Organization
Organization Name:CLINICA LAS MERCEDES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 STE 1100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7059
Mailing Address - Country:US
Mailing Address - Phone:786-233-6981
Mailing Address - Fax:786-322-2317
Practice Address - Street 1:2740 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4808
Practice Address - Country:US
Practice Address - Phone:954-334-3124
Practice Address - Fax:954-637-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center