Healthcare Provider Details

I. General information

NPI: 1790750529
Provider Name (Legal Business Name): CDT GMSP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B7 CALLE SANTA CRUZ AVE. SANTA CRUZ
BAYAMON PR
00961-6902
US

IV. Provider business mailing address

B7 CALLE SANTA CRUZ AVE. SANTA CRUZ
BAYAMON PR
00961-6902
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-9196
  • Fax: 787-625-6120
Mailing address:
  • Phone: 787-780-9196
  • Fax: 787-625-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1028
License Number StatePR

VIII. Authorized Official

Name: DR. ILIA E ZAYAS
Title or Position: EXUCUTIVE DIRECTOR
Credential: MD
Phone: 787-780-9196