Provider Demographics
NPI:1861629628
Name:CDT GMSP INC
Entity Type:Organization
Organization Name:CDT GMSP INC
Other - Org Name:CLINICA DE VACUNACION CDT GMSP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ILIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZAYAS-TORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-780-9196
Mailing Address - Street 1:B7 CALLE SANTA CRUZ
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6902
Mailing Address - Country:US
Mailing Address - Phone:787-780-9196
Mailing Address - Fax:
Practice Address - Street 1:B7 CALLE SANTA CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6902
Practice Address - Country:US
Practice Address - Phone:787-780-9196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038489500Medicaid