Provider Demographics
NPI:1700834629
Name:CDT RIVERA LABARCA
Entity Type:Organization
Organization Name:CDT RIVERA LABARCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-846-6890
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0359
Mailing Address - Country:US
Mailing Address - Phone:787-846-6890
Mailing Address - Fax:787-846-5458
Practice Address - Street 1:1 CALLE TOMAS DAVILA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2736
Practice Address - Country:US
Practice Address - Phone:787-846-6890
Practice Address - Fax:787-846-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR85261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85OtherSTATE LICENSE
PR85OtherSTATE LICENSE