Provider Demographics
NPI:1396848933
Name:CENTRO DE DIAGNOSTICO PULMONAR
Entity type:Organization
Organization Name:CENTRO DE DIAGNOSTICO PULMONAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISPULO
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-798-9701
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0040
Mailing Address - Country:US
Mailing Address - Phone:787-798-9701
Mailing Address - Fax:787-785-9580
Practice Address - Street 1:68 CALLE SANTA CRUZ STE 602
Practice Address - Street 2:68 STA CRUZ ST
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7035
Practice Address - Country:US
Practice Address - Phone:787-798-9701
Practice Address - Fax:787-785-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR900172OtherCRUZ AZUL
PR28374OtherTRIPLE S
PR=========OtherMMM
PR28374OtherTRIPLE S