| Organization Name: | CDT HORMIGUEROS PREVENTIVE MEDICINE, INC |
| NPI Number: | 1093069122 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JIMMY OLIVERA JAUME (ADMINISTRADOR) |
| Mailing Address: | 2 Munoz Rivera Street Hormigueros |
| State: | PR US |
| Postal Code: | 006600000 |
| Phone Number: | 7879357103 |
| Fax Number: | 7879357301 |
| NPI Enumeration Date: | 10/26/2012 |
| NPI Last Update Date: | 10/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 32 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |