Healthcare Provider Details

I. General information

NPI: 1164987855
Provider Name (Legal Business Name): CIDRA & MONTANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JOSE DE DIEGO 49
CIDRA PR
00739
US

IV. Provider business mailing address

PO BOX 2010
CAGUAS PR
00726-2010
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-5099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HECTOR RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-739-5099