Healthcare Provider Details

I. General information

NPI: 1063694453
Provider Name (Legal Business Name): CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE SAN SEBASTIAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JOSE MENDEZ CARDONA NUMERO 3
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

P O BOX 486
SAN SEBASTIAN PR
00685
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1850
  • Fax: 787-280-9497
Mailing address:
  • Phone: 787-896-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-896-1850