1831500057 NPI number — CENTRO DE DIAGNOSTICO Y TRATAMIENTO RIO GRANDE

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 1831500057 NPI number — CENTRO DE DIAGNOSTICO Y TRATAMIENTO RIO GRANDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE DIAGNOSTICO Y TRATAMIENTO RIO GRANDE
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:
CDT RIO GRANDE
Provider Other Organization Name Type Code:
3
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:
1831500057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70184
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:
00936-8184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-765-2929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#200 CALLE MANUEL PIMENTEL Y CASTRO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIO GRANDE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-809-1020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
BLANCA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SUPERVISORA
Authorized Official Telephone Number:
787-765-2929

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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