Healthcare Provider Details

I. General information

NPI: 1194941567
Provider Name (Legal Business Name): CENTRO DE DIAGNOSTICO Y TRATAMIENTO GUAYANILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CDT GUAYANILLA CALLE JOSE DE DIEGO #13
GUAYANILLA PR
00656
US

IV. Provider business mailing address

PO BOX 560550
GUAYANILLA PR
00656
US

V. Phone/Fax

Practice location:
  • Phone: 787-835-4254
  • Fax: 787-771-2295
Mailing address:
  • Phone: 787-835-4254
  • Fax: 787-771-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number07-B-3068
License Number StatePR

VIII. Authorized Official

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