Healthcare Provider Details

I. General information

NPI: 1497807473
Provider Name (Legal Business Name): CDT DORADO MEDICAL COMPLEX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 CALLE MENDEZ VIGO STE 10
DORADO PR
00646-4917
US

IV. Provider business mailing address

349 CALLE MENDEZ VIGO STE 10
DORADO PR
00646-4917
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number08F2467
License Number StatePR

VIII. Authorized Official

Name: JUDITH PEREZ
Title or Position: PHARMACIST
Credential: RPH
Phone: 787-278-1576