NPIMap

Organization Active NPI

Villa Los Santos Clinic, LLC

  • Diagnostic Radiology Physician
  • Arecibo, PR
National Provider Identifier
1144930645
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
VILLA LOS SANTOS CLINIC, LLC
Practice address
Villa Los Santos
Calle 16 V 1
Arecibo, PR 00612
Phone
(787) 879-1585
Fax
(787) 879-4315
NPI assigned
Nov 25, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Maria J Gonzalez Agraso
Title
Administradora
Phone
(787) 879-1585

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X

Addresses

Primary practice location

Villa Los Santos
Calle 16 V 1
Arecibo, PR 00612

Mailing address

PO Box 9091
Arecibo, PR 00613-9091
Phone (787) 879-1585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240618004494 PR Part B Supplier - Clinic/Group Practice 9032652037 Receives reassigned benefits from 18 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arecibo, PR

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Villa Los Santos Clinic LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1144930645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9091",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "006139091",
            "telephone_number": "787-879-1585",
            "fax_number": "787-879-4315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VILLA LOS SANTOS",
            "address_2": "CALLE 16 V 1",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "00612",
            "telephone_number": "787-879-1585",
            "fax_number": "787-879-4315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLA LOS SANTOS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-25",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ AGRASO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRADORA",
        "authorized_official_telephone_number": "787-879-1585",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arecibo, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.