1639396484 NPI number — CENTRO DE DIAGNOSTICO Y TRATAMIENTO PATILLAS

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639396484 NPI number — CENTRO DE DIAGNOSTICO Y TRATAMIENTO PATILLAS

Employer Identification Number (EIN):

Provider Organization Name:

CENTRO DE DIAGNOSTICO Y TRATAMIENTO PATILLAS

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 DE PATILLAS

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:

1639396484

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 PATILLAS

Provider Second Line Business Mailing Address:

P O BOX 697

Provider Business Mailing Address City Name:

PATILLAS

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00723

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-839-4360

Provider Business Mailing Address Fax Number:

787-271-0004

Provider First Line Business Practice Location Address:

CDT PATILLAS

Provider Second Line Business Practice Location Address:

CALLE RIEFKOL CARR. 3 KM. 27.1

Provider Business Practice Location Address City Name:

PATILLAS

Provider Business Practice Location Address State Name:

PR

Provider Business Practice Location Address Postal Code:

00731

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

787-839-4360

Provider Business Practice Location Address Fax Number:

787-271-0004

Provider Enumeration Date:

04/20/2007

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:  55 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 40154 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: SH33481 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 42032 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 6604363425P . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 19191 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 600350 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 1001752 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: S806 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 00381 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 101016 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 7230104 . This is a "E R" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".