Healthcare Provider Details

I. General information

NPI: 1114336914
Provider Name (Legal Business Name): CDT MARICAO MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 AVE LUCHETTI
MARICAO PR
00606-1310
US

IV. Provider business mailing address

PO BOX 938
HATILLO PR
00659-0938
US

V. Phone/Fax

Practice location:
  • Phone: 787-940-4685
  • Fax:
Mailing address:
  • Phone: 787-940-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number14450
License Number StatePR

VIII. Authorized Official

Name: DR. EDRICK N RAMIREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-940-4685