Provider Demographics
NPI:1144594839
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO SAN SEBASTIAN, INC.
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO SAN SEBASTIAN, INC.
Other - Org Name:CENTRO DE MEDICINA Y CIRUGIA AMBULATARIA DE SAN SEBASTIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-896-1850
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0486
Mailing Address - Country:US
Mailing Address - Phone:787-896-1850
Mailing Address - Fax:787-280-1698
Practice Address - Street 1:CALLE JOSE MENDEZ 903
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0000
Practice Address - Country:US
Practice Address - Phone:787-896-1850
Practice Address - Fax:787-280-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13-F-25073336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy