1497807473 NPI number — CDT DORADO MEDICAL COMPLEX INC

Table of content: (NPI 1497807473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497807473 NPI number — CDT DORADO MEDICAL COMPLEX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CDT DORADO MEDICAL COMPLEX 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:
1497807473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 CALLE MENDEZ VIGO
Provider Second Line Business Mailing Address:
STE 10
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646-4917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
349 CALLE MENDEZ VIGO
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
DORADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00646-4917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-278-1576
Provider Business Practice Location Address Fax Number:
787-278-0936
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
787-278-1576

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  08F2467 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4025551 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4025551 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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