Provider Demographics
NPI:1780801563
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO YABUCOA
Entity type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO YABUCOA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:787-771-2100
Mailing Address - Street 1:CDT YABUCOA
Mailing Address - Street 2:P O BOX 8548
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-893-0480
Mailing Address - Fax:787-771-2295
Practice Address - Street 1:CDT YABUCOA
Practice Address - Street 2:CARR.901 CALLE SATURNINO RODRIGUEZ #100
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-0480
Practice Address - Fax:787-771-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR63261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR09222OtherE R
PR7670044OtherE R
PR600010OtherE R
PRS329OtherE R
PR1000675OtherE R
PR00380OtherE R
PR030764OtherE R
PR6604363425YOtherE R
PRSH00804OtherE R
PR19068OtherE R
PR40157OtherE R
PR1000675OtherE R
PR6604363425YOtherE R