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General NPI Number Information
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NPI Number | 1841746997
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Entity Type | Organization
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Legal Business Name | CDVA CORP
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | CARR 149 KM 58.3 MARGINAL 118A SECTOR JAGUEYES
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City | VILLALBA
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State | PR
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Zip | 00766
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Country | US
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Telephone | 787-569-3646
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Fax |
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Provider Business Mailing Address
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Address Line | CARR 149 KM 58.3 MARGINAL 118A SECTOR JAGUEYES
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City | VILLALBA
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State | PR
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Zip | 00766
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Country | US
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Telephone | 787-569-3646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TENSY L CINTRON
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Credential | MT
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Telephone | 787-344-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 18-B-6816
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License Number State | PR
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