Healthcare Provider Details

I. General information

NPI: 1316348840
Provider Name (Legal Business Name): CENTRO DE DIABETES Y ENDOCRINOLOGIA DE MANATI C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR # 2 KM 47.17 CENTRO DE DIABETES Y ENDOCRINOLOGIA DR RAMON ORTIZ
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1100
MANATI PR
00674-1100
US

V. Phone/Fax

Practice location:
  • Phone: 787-904-7700
  • Fax: 787-884-4455
Mailing address:
  • Phone: 787-904-7700
  • Fax: 787-884-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4852
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RAMON ORTIZ CARRASQUILLO
Title or Position: ENDOCRINOLOGIST
Credential: M.D.
Phone: 787-854-1779