Provider Demographics
NPI:1194941567
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO GUAYANILLA
Entity type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO GUAYANILLA
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:PO BOX 560550
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656
Mailing Address - Country:US
Mailing Address - Phone:787-835-4254
Mailing Address - Fax:787-771-2295
Practice Address - Street 1:CDT GUAYANILLA
Practice Address - Street 2:CALLE JOSE DE DIEGO #13
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656
Practice Address - Country:US
Practice Address - Phone:787-835-4254
Practice Address - Fax:787-771-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-B-3068261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6700165OtherER
PRS331OtherER
PR09992OtherER
PR030707OtherER
PR19104OtherER
PR00378OtherER
PR1000314OtherER
PR40150OtherER
PR600328OtherER
PRSH00409OtherER
PR=========GOtherER