Healthcare Provider Details

I. General information

NPI: 1245566447
Provider Name (Legal Business Name): CDT DE VEGA BAJA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA PINARES CALLE PASEO VILLA PINARES 81
VEGA BAJA PUERTO RICO
00693
UM

IV. Provider business mailing address

PO BOX 1388
CAGUAS PUERTO RICO
00726
UM

V. Phone/Fax

Practice location:
  • Phone: 787-858-2416
  • Fax: 787-744-8065
Mailing address:
  • Phone: 787-745-0708
  • Fax: 787-744-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE M RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-745-0708