Healthcare Provider Details

I. General information

NPI: 1215082060
Provider Name (Legal Business Name): CDT POLICLINICA FAMILIAR FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 CALLE ARIZMENDI
FLORIDA PR
00650-2006
US

IV. Provider business mailing address

PO BOX 1336
HATILLO PR
00659-1336
US

V. Phone/Fax

Practice location:
  • Phone: 787-822-3446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number986
License Number StatePR

VIII. Authorized Official

Name: VILMA M PADILLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-822-3446