Provider Demographics
NPI:1861167124
Name:CLINICA SANAMED LLC
Entity type:Organization
Organization Name:CLINICA SANAMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONA AUTORIZADA
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-674-4124
Mailing Address - Street 1:562 SUMMIT HILLS
Mailing Address - Street 2:CALLE GREENWOOD
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-4322
Mailing Address - Country:US
Mailing Address - Phone:939-945-8458
Mailing Address - Fax:
Practice Address - Street 1:CROWN HILL CALLE CARITE 125
Practice Address - Street 2:ESQUINA AVE. PARANA, LOCAL #2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:939-945-8458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty