Provider Demographics
NPI:1841746997
Name:CDVA CORP
Entity type:Organization
Organization Name:CDVA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TENSY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-344-9800
Mailing Address - Street 1:CARR 149 KM 58.3 MARGINAL 118A
Mailing Address - Street 2:SECTOR JAGUEYES
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-569-3646
Mailing Address - Fax:
Practice Address - Street 1:CARR 149 KM 58.3 MARGINAL 118A
Practice Address - Street 2:SECTOR JAGUEYES
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-569-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-B-6816302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization