Healthcare Provider Details

I. General information

NPI: 1104033356
Provider Name (Legal Business Name): CENTRO DE DIAGNOSTICO Y TRATAMIENTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE QUINONES
MANATI PR
00674-5013
US

IV. Provider business mailing address

CARR. # 10 KM. 50.0
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-2292
  • Fax: 787-854-2092
Mailing address:
  • Phone: 787-854-2292
  • Fax: 787-854-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier4948
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerINTERNATIONAL MEDICAL CAR

VIII. Authorized Official

Name: MR. JUAN AUBIN CRUZ
Title or Position: ALCALDE
Credential:
Phone: 787-854-2292