Healthcare Provider Details

I. General information

NPI: 1437586344
Provider Name (Legal Business Name): CENTRO DE DIAGNOSTICO Y TRATAMIENTO VEGA BAJA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE VILLA PASEOS #81 URB. VILLA PINARES
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 70184
SAN JUAN PR
00936-8184
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-2416
  • Fax:
Mailing address:
  • Phone: 787-852-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUDA A TRICOCHE
Title or Position: DIRECTORA
Credential:
Phone: 787-771-2100