Healthcare Provider Details

I. General information

NPI: 1700834629
Provider Name (Legal Business Name): CDT RIVERA LABARCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE TOMAS DAVILA
BARCELONETA PR
00617-2736
US

IV. Provider business mailing address

PO BOX 359
BARCELONETA PR
00617-0359
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-6890
  • Fax: 787-846-5458
Mailing address:
  • Phone: 787-846-6890
  • Fax: 787-846-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number85
License Number StatePR

VIII. Authorized Official

Name: DR. YONATHAN RIVERA JIMENEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-846-6890