Provider Demographics
NPI:1518290881
Name:CDT TOA ALTA PUEBLO
Entity Type:Organization
Organization Name:CDT TOA ALTA PUEBLO
Other - Org Name:SM MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMONS FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-230-7190
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-230-7190
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE ANTONIO R BARCELO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-230-7190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAB CDT TOA ALTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-17
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR61261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care