Provider Demographics
NPI:1386794857
Name:CDT DORADO MEDICAL COMPLEX, INC.
Entity type:Organization
Organization Name:CDT DORADO MEDICAL COMPLEX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-278-1576
Mailing Address - Street 1:349 CALLE MENDEZ VIGO
Mailing Address - Street 2:SUITE #10
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4917
Mailing Address - Country:US
Mailing Address - Phone:787-278-1576
Mailing Address - Fax:787-278-0936
Practice Address - Street 1:349 CALLE MENDEZ VIGO
Practice Address - Street 2:SUITE # 10
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4917
Practice Address - Country:US
Practice Address - Phone:787-278-1576
Practice Address - Fax:787-278-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0002X
PR06223261QR0200X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty