1770568750 NPI number — CENTRO DE DIAGNOSTICO Y TRATAMIENTO OFTALMOLOGICO, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770568750 NPI number — CENTRO DE DIAGNOSTICO Y TRATAMIENTO OFTALMOLOGICO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE DIAGNOSTICO Y TRATAMIENTO OFTALMOLOGICO, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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 Information

NPI Number:
1770568750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41281
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00940-1281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-725-9315
Provider Business Mailing Address Fax Number:
787-724-4654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE DE DIEGO 150
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-725-9318
Provider Business Practice Location Address Fax Number:
787-724-4654
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
MARIA H
Authorized Official Middle Name:
BERROCAL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-725-9315

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28337 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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