Healthcare Provider Details

I. General information

NPI: 1336632702
Provider Name (Legal Business Name): ZCR ID CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 445 KM 2.7 BARRIO SALTOS
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

HC 6 BOX 17376
SAN SEBASTIAN PR
00685-9926
US

V. Phone/Fax

Practice location:
  • Phone: 787-249-6472
  • Fax:
Mailing address:
  • Phone: 787-249-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18421
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ZAYDALEE CARDONA RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-249-6472