Provider Demographics
NPI:1033393921
Name:CENTRO DIAGNOSTICO Y TRATAMIENTO DE RIO GRANDE
Entity Type:Organization
Organization Name:CENTRO DIAGNOSTICO Y TRATAMIENTO DE RIO GRANDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-809-1010
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0847
Mailing Address - Country:US
Mailing Address - Phone:787-809-1010
Mailing Address - Fax:787-888-1832
Practice Address - Street 1:CALLE MANUEL PIMENTEL Y CASTRO 200
Practice Address - Street 2:PUEBLO
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-0000
Practice Address - Country:US
Practice Address - Phone:787-809-1010
Practice Address - Fax:787-888-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR962291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory