Organization
CDT HORMIGUEROS PREVENTIVE MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMY OLIVERA JAUME (ADMINISTRADOR)
(787) 484-8273
Entity
Organization
Contact information
Practice address
2 MUNOZ RIVERA STREET, HORMIGUEROS, PR 00660-0000
(787) 935-7103
(787) 935-7301
Mailing address
PO BOX 1550, HORMIGUEROS, PR 00660-5550
(787) 935-7103
(787) 935-7301
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
32
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-B-5586
LIC BOTIQUIN
PR
01
—
9278-12
LIC PRODUCTOS BIOLOGICOS
PR
Enumeration date
10/26/2012
Last updated
10/26/2012
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