Healthcare Provider Details

I. General information

NPI: 1073830113
Provider Name (Legal Business Name): CDT PENA POBRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO PENA POBRE
NAGUABO PR
00718
US

IV. Provider business mailing address

PO BOX 40
NAGUABO PR
00718-0040
US

V. Phone/Fax

Practice location:
  • Phone: 787-874-3037
  • Fax:
Mailing address:
  • Phone: 787-750-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberTCAMB653
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTCAMB653
License Number StatePR

VIII. Authorized Official

Name: MRS. MARIA E MELENDEZ
Title or Position: ASESOR
Credential: MRS
Phone: 787-750-2697