Healthcare Provider Details

I. General information

NPI: 1417251273
Provider Name (Legal Business Name): PDP HEALTH MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZOLETA MOREL CAMPOS LOCAL #9
PONCE PUERTO RICO
00732
UM

IV. Provider business mailing address

PMB 261 APTDO 7105
PONCE PUERTO RICO
00732
UM

V. Phone/Fax

Practice location:
  • Phone: 787-812-3193
  • Fax: 787-290-6689
Mailing address:
  • Phone: 787-812-3193
  • Fax: 787-290-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTIN AVILES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-812-3193