Provider Demographics
NPI:1457565194
Name:CDT DR. JOSE S. BELAVAL
Entity Type:Organization
Organization Name:CDT DR. JOSE S. BELAVAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-480-5042
Mailing Address - Street 1:PO BOX 21405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1405
Mailing Address - Country:US
Mailing Address - Phone:787-480-3876
Mailing Address - Fax:787-977-8401
Practice Address - Street 1:2018 AVE. BORINQUEN ESQUINA CALLE NIN BO OBRERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915
Practice Address - Country:US
Practice Address - Phone:787-480-5042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherGOLDEN CROSS
PR=========Medicaid
PR=========OtherFIRST MEDICAL MC
PR=========OtherCIGNA EXCLUSIVE
PR=========OtherHUMANA HEALTH PLAN
PR=========OtherAMERICAN HEALTH
PR=========OtherCOSVIMED CARE C
PR=========OtherHUMANA GOLF PLUS
PR=========OtherCOSVI PRIVADO
PR=========OtherCRUZ AZUL
PR=========OtherACCA
PR=========OtherMCS LIFE
PR=========OtherPAN AMERICAN
PR=========OtherCOSVI REFORMA
PR=========OtherGOLDEN CROSS
PR=========Medicare ID - Type UnspecifiedPREFERRED MED CHOICE
PR=========OtherHUMANA HEALTH PLAN
PR=========OtherCIGNA EXCLUSIVE
PR=========OtherCRUZ AZUL