Provider Demographics
NPI:1962684357
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE SAN SEBASTIAN INC
Entity Type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE SAN SEBASTIAN INC
Other - Org Name:LABORATORIO CLINICO DEL CDT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-896-1850
Mailing Address - Street 1:P O BOX 486
Mailing Address - Street 2:CALLE JOSE MENDEZ CARDONA
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-896-1850
Mailing Address - Fax:787-280-1698
Practice Address - Street 1:CALLE JOSE MENDEZ CARDONA NUMERO 3
Practice Address - Street 2:LABORATORIO CLIN DEL CDT
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038160Medicare UPIN