1790750529 NPI number — CDT GMSP, 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 1790750529 NPI number — CDT GMSP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CDT GMSP, 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:
6
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:
1790750529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
B7 CALLE SANTA CRUZ
Provider Second Line Business Mailing Address:
AVE. SANTA CRUZ
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-6902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-780-9196
Provider Business Mailing Address Fax Number:
787-625-6120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
B7 CALLE SANTA CRUZ
Provider Second Line Business Practice Location Address:
AVE. SANTA CRUZ
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-780-9196
Provider Business Practice Location Address Fax Number:
787-625-6120
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZAYAS
Authorized Official First Name:
ILIA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EXUCUTIVE DIRECTOR
Authorized Official Telephone Number:
787-780-9196

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1028 , 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: 1790750529 . This is a "NPI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0039200 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 037546800 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40D0699278 . This is a "CLIA NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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