Provider Demographics
NPI:1497807473
Name:CDT DORADO MEDICAL COMPLEX INC
Entity Type:Organization
Organization Name:CDT DORADO MEDICAL COMPLEX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-278-1576
Mailing Address - Street 1:349 CALLE MENDEZ VIGO
Mailing Address - Street 2:STE 10
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:349 CALLE MENDEZ VIGO
Practice Address - Street 2:STE 10
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4917
Practice Address - Country:US
Practice Address - Phone:787-278-1576
Practice Address - Fax:787-278-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08F24673336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4025551OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4025551OtherOTHER ID NUMBER