Healthcare Provider Details

I. General information

NPI: 1205540010
Provider Name (Legal Business Name): CDT DIAGNOSTIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CALLE PROGRESO
AGUADILLA PR
00603-4802
US

IV. Provider business mailing address

P.O. BOX 142
AGUADILLA PR
00605
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-1070
  • Fax: 787-882-1070
Mailing address:
  • Phone: 201-463-8004
  • Fax: 201-464-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS M BENALCAZAR-PUGA
Title or Position: PHYSICIAN
Credential: MD
Phone: 201-463-8004