Healthcare Provider Details

I. General information

NPI: 1013129444
Provider Name (Legal Business Name): CIDRA EMERGENCY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 AVE LUIS MUNOZ RIVERA S
CAYEY PR
00736-4703
US

IV. Provider business mailing address

114 AVE LUIS MUNOZ RIVERA S
CAYEY PR
00736-4703
US

V. Phone/Fax

Practice location:
  • Phone: 787-396-0816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RUBEN MENDEZ BENABE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-396-0816