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General NPI Number Information
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NPI Number | 1396848933
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Entity Type | Organization
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Legal Business Name | CENTRO DE DIAGNOSTICO PULMONAR
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 68 CALLE SANTA CRUZ STE 602 68 STA CRUZ ST
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City | BAYAMON
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State | PR
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Zip | 00961-7035
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Country | US
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Telephone | 787-798-9701
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Fax | 787-785-9580
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | BAYAMON
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State | PR
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Zip | 00960-0040
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Country | US
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Telephone | 787-798-9701
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Fax | 787-785-9580
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRISPULO M RIVERA
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Credential | MD
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Telephone | 787-798-9701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3000
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License Number State | PR
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