Healthcare Provider Details

I. General information

NPI: 1427339316
Provider Name (Legal Business Name): CDMA MEDICAL CORPORATION, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE JESUS T PINERO # 282 PLAZA EL AMAL SUITE 204
SAN JUAN PR
00918-4003
US

IV. Provider business mailing address

AVE JESUS T PINERO 282 PLAZA EL AMAL SUITE 204
SAN JUAN PR
00927
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-7799
  • Fax: 787-296-8447
Mailing address:
  • Phone: 787-751-7799
  • Fax: 787-296-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: ERNESTO B HERGER
Title or Position: DIRECTOR
Credential:
Phone: 787-751-7799