Provider Demographics
NPI:1912970351
Name:LOS ANGELES MEDICAL CLINIC CORP
Entity type:Organization
Organization Name:LOS ANGELES MEDICAL CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-721-0429
Mailing Address - Street 1:1400 CALLE SAN RAFAEL
Mailing Address - Street 2:ESQ HIPODROMO SUITE 201
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2693
Mailing Address - Country:US
Mailing Address - Phone:787-721-6626
Mailing Address - Fax:787-725-1287
Practice Address - Street 1:1400 CALLE SAN RAFAEL
Practice Address - Street 2:ESQ HIPODROMO SUITE 201
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2644
Practice Address - Country:US
Practice Address - Phone:787-721-6626
Practice Address - Fax:787-725-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR70103TC0700X
PR1820103TC0700X
PR013924207Q00000X
PR11058207Q00000X
PR9251207R00000X
PR4847207RC0000X
PR8908207RP1001X
PR10561207V00000X
PR15909208100000X
PR16296208D00000X
PR624225100000X
PR16341208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4172OtherPMC
PR9090182OtherHUMANA
PR3153261OtherUIA
PR04486OtherAMERICAN HEALTH INC
PR9080048OtherHUMANA
PR3842OtherAMERICAN HEALTH MEDICARE
PR4965OtherPALI
PR=========OtherMIDI
PR=========OtherAPS
PR4172OtherPMC
PR9080048OtherHUMANA
PR9090182OtherHUMANA
PR=========OtherMMM
PR=========OtherFHCHS
PR=========OtherAUXILIO PLATINO
PR=========OtherMAPFRE
PR04486OtherAMERICAN HEALTH INC
PR4965OtherPALI
PR=========OtherMAPFRE EXCELL