Provider Demographics
NPI:1831646942
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO CEIBA MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO CEIBA MEDICAL CENTER
Other - Org Name:CDT CEIBA
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVERAS-LAGUNA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-801-0081
Mailing Address - Street 1:CALLE ESCOLASTICO LOPEZ
Mailing Address - Street 2:ANTIGUA ESCUELA SANTA ROSA
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735
Mailing Address - Country:US
Mailing Address - Phone:787-801-0081
Mailing Address - Fax:787-801-0087
Practice Address - Street 1:CALLE ESCOLASTICO LOPEZ
Practice Address - Street 2:ANTIGUA ESCUELA SANTA ROSA
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735
Practice Address - Country:US
Practice Address - Phone:787-801-0081
Practice Address - Fax:787-801-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9630-14261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care