Provider Demographics
NPI:1750409389
Name:CLINICA CUIDADO MEDICO INC
Entity type:Organization
Organization Name:CLINICA CUIDADO MEDICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-871-1098
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1347
Mailing Address - Country:US
Mailing Address - Phone:787-871-1098
Mailing Address - Fax:787-871-4883
Practice Address - Street 1:4 CALLE HOSPITAL
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3310
Practice Address - Country:US
Practice Address - Phone:787-871-1098
Practice Address - Fax:787-871-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2015-02-18
Deactivation Date:2012-04-05
Deactivation Code:
Reactivation Date:2015-02-10
Provider Licenses
StateLicense IDTaxonomies
PR04F1945261Q00000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17099Medicare ID - Type Unspecified