Provider Demographics
NPI:1437586344
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO VEGA BAJA
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO VEGA BAJA
Other - Org Name:CDT VEGA BAJA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRICOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-771-2100
Mailing Address - Street 1:PO BOX 70184
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8184
Mailing Address - Country:US
Mailing Address - Phone:787-852-2416
Mailing Address - Fax:
Practice Address - Street 1:CALLE VILLA PASEOS #81
Practice Address - Street 2:URB. VILLA PINARES
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-852-2416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care