Provider Demographics
NPI:1164466363
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE SAN SEBASTIAN INC
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE SAN SEBASTIAN INC
Other - Org Name:SALA DE EMERGENCIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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 1:3 JOSE MENDEZ CARDONA AVE.
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0486
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:2006-06-16
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081070Medicare PIN