Healthcare Provider Details

I. General information

NPI: 1427371145
Provider Name (Legal Business Name): CDT HORMIGUEROS PREVENTIVE MEDICINE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2, RUIZ BELVIS ST CDT HORMIGUEROS PREVENTIVE MEDICINE INC
HORMIGUEROS PR
00660-0097
US

IV. Provider business mailing address

PO BOX 2669
BAYAMON PR
00960-2669
US

V. Phone/Fax

Practice location:
  • Phone: 787-464-1384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CARLOS MIRANDA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-464-1384