Provider Demographics
NPI:1528288867
Name:CLINICA ESPECIALIZADA DR. ANGEL M. LOYOLA RIVERA PSC
Entity type:Organization
Organization Name:CLINICA ESPECIALIZADA DR. ANGEL M. LOYOLA RIVERA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:LOYOLA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-856-2600
Mailing Address - Street 1:PO BOX 3048
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3048
Mailing Address - Country:US
Mailing Address - Phone:787-856-2600
Mailing Address - Fax:
Practice Address - Street 1:AVE. 128 KM 1.1 HOPITAL METROPOLITANO DR. TITO MATTEI
Practice Address - Street 2:SUITE 118 A
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3048
Practice Address - Country:US
Practice Address - Phone:787-856-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICA ESPECIALIZADA DR. ANGEL M. LOYOLA RIVERA PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-27
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6828261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care