Provider Demographics
NPI:1578309332
Name:CLINICA GRATITUD LLC
Entity type:Organization
Organization Name:CLINICA GRATITUD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACKELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCIAL RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:787-560-1254
Mailing Address - Street 1:26 PARC ESPINAL
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-3165
Mailing Address - Country:US
Mailing Address - Phone:939-224-6074
Mailing Address - Fax:
Practice Address - Street 1:BO CAMASEYES WORD F112 CALLE B 4
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:939-224-6074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)