Provider Demographics
NPI:1639396484
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO PATILLAS
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO PATILLAS
Other - Org Name:CDT DE PATILLAS
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:787-771-2100
Mailing Address - Street 1:CDT PATILLAS
Mailing Address - Street 2:P O BOX 697
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723
Mailing Address - Country:US
Mailing Address - Phone:787-839-4360
Mailing Address - Fax:787-271-0004
Practice Address - Street 1:CDT PATILLAS
Practice Address - Street 2:CALLE RIEFKOL CARR. 3 KM. 27.1
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-839-4360
Practice Address - Fax:787-271-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR55261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40154OtherE R
PRSH33481OtherE R
PR42032OtherE R
PR6604363425POtherE R
PR19191OtherE R
PR600350OtherE R
PR1001752OtherE R
PRS806OtherE R
PR00381OtherE R
PR101016OtherE R
PR7230104OtherE R
PR6604363425POtherE R
PR=========POtherE R
PRS806OtherE R