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General NPI Number Information
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NPI Number | 1861629628
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Entity Type | Organization
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Legal Business Name | CDT GMSP INC
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | B7 CALLE SANTA CRUZ
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City | BAYAMON
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State | PR
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Zip | 00961-6902
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Country | US
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Telephone | 787-780-9196
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Fax |
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Provider Business Mailing Address
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Address Line | B7 CALLE SANTA CRUZ
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City | BAYAMON
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State | PR
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Zip | 00961-6902
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Country | US
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Telephone | 787-780-9196
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ILIA E ZAYAS-TORO
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Credential | MD
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Telephone | 787-780-9196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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