=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114120268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRO DE DIAGNOSTICO Y TRATAMIENTO GUANICA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARRETERA 116 KM. 27.7
-----------------------------------------------------
City | GUANICA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-821-0402
-----------------------------------------------------
Fax | 787-821-0402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 785
-----------------------------------------------------
City | GUANICA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-821-1481
-----------------------------------------------------
Fax | 787-771-2295
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTORA EJECUTIVA
-----------------------------------------------------
Name | MRS. CARMEN R RODRIGUEZ
-----------------------------------------------------
Credential | MPA
-----------------------------------------------------
Telephone | 787-771-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------