Provider Demographics
NPI:1598985889
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO LOIZA
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO LOIZA
Other - Org Name:CDT LOIZA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:787-771-2295
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0509
Mailing Address - Country:US
Mailing Address - Phone:787-876-2245
Mailing Address - Fax:787-771-2295
Practice Address - Street 1:CARRT. 188 KM5 HM 6
Practice Address - Street 2:INT. 187
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-2245
Practice Address - Fax:787-771-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5365-05261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10112OtherE R
PR1001744OtherE R
PRSH00154OtherE R
PR00431OtherE R
PR40152OtherE R
PR7720006OtherE R
PW19190OtherE R
PR600349OtherE R
PRS809OtherE R
PRS809OtherE R