Healthcare Provider Details

I. General information

NPI: 1235536640
Provider Name (Legal Business Name): CDT MARICAO MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. LUCHETTI NUMERO 9
MARICAO PR
00606
US

IV. Provider business mailing address

AVE LUCHETTI NUMERO 9
MARICAO PR
00606
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 Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberSALUD RADIOLOGICA PR
License Number StatePR

VIII. Authorized Official

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