Provider Demographics
NPI:1225429533
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE RIO GRANDE
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE RIO GRANDE
Other - Org Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE RIO GRANDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVERAS-LAGUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-801-0081
Mailing Address - Street 1:CALL BOX 70006
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NUMERO 200 CALLE MANUEL PIMENTEL Y CASTRO
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-801-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIBE PHYSICIANS PLAZA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-09
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN