Healthcare Provider Details

I. General information

NPI: 1447391685
Provider Name (Legal Business Name): CDT DE CANOVANAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. CORCHADO FINAL
CANOVANAS PR
00729-2003
US

IV. Provider business mailing address

PO BOX 2003
CANOVANAS PR
00729-2003
US

V. Phone/Fax

Practice location:
  • Phone: 787-876-5000
  • Fax: 787-886-2203
Mailing address:
  • Phone: 787-876-5000
  • Fax: 787-886-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO SOTOMAYOR
Title or Position: ADMINISTRADOR
Credential: MHSA 79
Phone: 787-420-0213