Provider Demographics
NPI:1467859736
Name:CDT MARICAO MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:CDT MARICAO MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-940-4685
Mailing Address - Street 1:AVE. LUCHETTI NUM. 9
Mailing Address - Street 2:
Mailing Address - City:MARICAO
Mailing Address - State:PR
Mailing Address - Zip Code:00606
Mailing Address - Country:US
Mailing Address - Phone:787-940-4685
Mailing Address - Fax:
Practice Address - Street 1:9 AVE LUCHETTI
Practice Address - Street 2:
Practice Address - City:MARICAO
Practice Address - State:PR
Practice Address - Zip Code:00606-1310
Practice Address - Country:US
Practice Address - Phone:787-940-4685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR49291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory