Healthcare Provider Details

I. General information

NPI: 1265687362
Provider Name (Legal Business Name): CENTRO DE DIAGNOSTICO Y TRATAMIENTO NAGUABO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 31 KM. 4.0
NAGUABO PR
00718
US

IV. Provider business mailing address

CARR. 31 KM 4.0
NAGUABO PR
00718
US

V. Phone/Fax

Practice location:
  • Phone: 787-837-2837
  • Fax: 787-771-2295
Mailing address:
  • Phone: 787-874-2837
  • Fax: 787-771-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateRI

VIII. Authorized Official

Name: MRS. CARMEN R RODRIGUEZ
Title or Position: DIRECTORA EJECUTIVA
Credential: MPA
Phone: 787-771-2100