Healthcare Provider Details

I. General information

NPI: 1326343385
Provider Name (Legal Business Name): CENTRO DE DIAGNOSTICO Y TRATAMIENTO MPL COROZAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MARINA NUMERO 13
COROZAL PR
00783
US

IV. Provider business mailing address

PO BOX 51991
TOA BAJA PR
00950-1991
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-1983
  • Fax: 787-706-8823
Mailing address:
  • Phone: 787-707-1983
  • Fax: 787-706-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR R DIAZ
Title or Position: DIRECTOR EJECUTIVO
Credential:
Phone: 787-707-1983