Healthcare Provider Details

I. General information

NPI: 1386794857
Provider Name (Legal Business Name): CDT DORADO MEDICAL COMPLEX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 CALLE MENDEZ VIGO SUITE # 10
DORADO PR
00646-4917
US

IV. Provider business mailing address

349 CALLE MENDEZ VIGO SUITE #10
DORADO PR
00646-4917
US

V. Phone/Fax

Practice location:
  • Phone: 787-278-1576
  • Fax: 787-278-0936
Mailing address:
  • Phone: 787-278-1576
  • Fax: 787-278-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number06223
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number06223
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS A PAGAN
Title or Position: VICEPRESIDENT
Credential: MD
Phone: 787-278-1576