Provider Demographics
NPI:1124248414
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE NAGUABO
Entity type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE NAGUABO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:787-771-2100
Mailing Address - Street 1:CARRT. NUM. 31 KM 4.0
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718
Mailing Address - Country:US
Mailing Address - Phone:787-874-3125
Mailing Address - Fax:787-874-3120
Practice Address - Street 1:CARRT. NUM. 31 KM 4.0
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-874-3125
Practice Address - Fax:787-874-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR52261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR09212OtherE R
PR7180019OtherE R
PR00383OtherE R
PR030760OtherE R
PR1000624OtherE R
PR40153OtherE R
PRSH00804OtherE R
PR19074OtherE R
PR600020OtherE R
PRS333OtherE R
PR600020OtherE R
PR09212OtherE R