Provider Demographics
NPI:1407932346
Name:CENTRE DE DIAGNOSTICO Y TRATAMIENTO
Entity Type:Organization
Organization Name:CENTRE DE DIAGNOSTICO Y TRATAMIENTO
Other - Org Name:FARMACIA CDT GMSP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ILIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-780-9196
Mailing Address - Street 1:URB SANTA CRUZ
Mailing Address - Street 2:B7 CALLE SANTA CRUZ
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-786-1325
Mailing Address - Fax:787-778-2280
Practice Address - Street 1:URB SANTA CRUZ
Practice Address - Street 2:MARGINAL C-17
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-1325
Practice Address - Fax:787-778-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-3386333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4023836OtherNABP
PR037723800Medicaid