Provider Demographics
NPI:1316675192
Name:CDTMOVIL
Entity type:Organization
Organization Name:CDTMOVIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:RODRIGUEZ-RESTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-392-5878
Mailing Address - Street 1:251 CALLE VIOLETAS E-14 URB SAN RAFAEL ESTATES
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-787-4623
Mailing Address - Fax:
Practice Address - Street 1:251 CALLE VIOLETAS E-14 URB SAN RAFAEL ESTATES
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-4623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty