Healthcare Provider Details

I. General information

NPI: 1841746997
Provider Name (Legal Business Name): CDVA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 149 KM 58.3 MARGINAL 118A SECTOR JAGUEYES
VILLALBA PR
00766
US

IV. Provider business mailing address

CARR 149 KM 58.3 MARGINAL 118A SECTOR JAGUEYES
VILLALBA PR
00766
US

V. Phone/Fax

Practice location:
  • Phone: 787-569-3646
  • Fax:
Mailing address:
  • Phone: 787-569-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number18-B-6816
License Number StatePR

VIII. Authorized Official

Name: MRS. TENSY L CINTRON
Title or Position: OWNER
Credential: MT
Phone: 787-344-9800