Healthcare Provider Details

I. General information

NPI: 1114120268
Provider Name (Legal Business Name): CENTRO DE DIAGNOSTICO Y TRATAMIENTO GUANICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 116 KM. 27.7
GUANICA PR
00653
US

IV. Provider business mailing address

P O BOX 785
GUANICA PR
00653
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-0402
  • Fax: 787-821-0402
Mailing address:
  • Phone: 787-821-1481
  • Fax: 787-771-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. CARMEN R RODRIGUEZ
Title or Position: DIRECTORA EJECUTIVA
Credential: MPA
Phone: 787-771-2100