Healthcare Provider Details

I. General information

NPI: 1861943219
Provider Name (Legal Business Name): CDT LAS MARIAS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 119 KM 24.0
LAS MARIAS PR
00670
US

IV. Provider business mailing address

PO BOX 938
HATILLO PR
00659-0938
US

V. Phone/Fax

Practice location:
  • Phone: 787-895-6315
  • Fax:
Mailing address:
  • Phone: 787-895-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDRICK N RAMIREZ
Title or Position: PRESIDENTE
Credential:
Phone: 17878956315