Healthcare Provider Details

I. General information

NPI: 1659330884
Provider Name (Legal Business Name): CENTRO DIAGNOSTICO Y TRATAMIENTO DR CAPARROS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE BETANCES 2
UTUADO PR
00641
US

IV. Provider business mailing address

PO BOX 569
CAMUY PR
00627-0569
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-2288
  • Fax: 787-894-5731
Mailing address:
  • Phone: 787-894-2288
  • Fax: 787-894-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number76
License Number StatePR

VIII. Authorized Official

Name: MRS. MARISOL GONZALEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-894-2288