1710106216 NPI number — CENTRO DIAGNOSTICO Y TRATAMIENTO DE SANTA ISABEL

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710106216 NPI number — CENTRO DIAGNOSTICO Y TRATAMIENTO DE SANTA ISABEL

Employer Identification Number (EIN):

Provider Organization Name:

CENTRO DIAGNOSTICO Y TRATAMIENTO DE SANTA ISABEL

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

CDT SANTA ISABEL

Provider Other Organization Name Type Code:

5

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1710106216

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/22/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

CDT SANTA ISABEL

Provider Second Line Business Mailing Address:

PO BOX 725

Provider Business Mailing Address City Name:

SANTA ISABEL

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00757

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-845-5050

Provider Business Mailing Address Fax Number:

787-845-3320

Provider First Line Business Practice Location Address:

CDT SANTA ISABEL

Provider Second Line Business Practice Location Address:

CALLE HOSTOS FINAL CARR.153

Provider Business Practice Location Address City Name:

SANTA ISABEL

Provider Business Practice Location Address State Name:

PR

Provider Business Practice Location Address Postal Code:

00757

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

787-845-5050

Provider Business Practice Location Address Fax Number:

787-845-3320

Provider Enumeration Date:

04/24/2007

Authorized Official Last Name:

RODRIGUEZ

Authorized Official First Name:

CARMEN

Authorized Official Middle Name:

R

Authorized Official Title or Position:

DIRECTORA EJECUTIVA

Authorized Official Telephone Number:

787-771-2100

• Taxonomy code: 261QE0002X , with the licence number:  82 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 10042 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 030763 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: S334 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 600126 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 40155 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 00369 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 1000667 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 19067 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 7570025 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: SH00414 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".