Provider Demographics
NPI:1831500057
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO RIO GRANDE
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO RIO GRANDE
Other - Org Name:CDT RIO GRANDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-2929
Mailing Address - Street 1:PO BOX 70184
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8184
Mailing Address - Country:US
Mailing Address - Phone:787-765-2929
Mailing Address - Fax:
Practice Address - Street 1:#200 CALLE MANUEL PIMENTEL Y CASTRO
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00749
Practice Address - Country:US
Practice Address - Phone:787-809-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care