NPIMap

Organization Active NPI

Villa Los Santos Clinic, LLC

  • Primary Care Clinic/Center
  • Arecibo, PR
National Provider Identifier
1861100869
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
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 8, 2022
Last updated
Jun 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Authorized official

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU
Nutritionist 133N00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU
Multi-Specialty Clinic/Center 261QM1300X NU
Primary Care Clinic/Center 261QP2300X NU Primary

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
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 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1861100869",
    "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": "2022-11-08",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "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"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "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 Jun 24, 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.