Organization
CDT HORMIGUEROS PREVENTIVE MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMY OLIVERA JAUME (ADMINISTRATOR)
(787) 484-8273
Entity
Organization
Contact information
Practice address
2 MUNOZ MARIN 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
291U00000X
Clinical Medical Laboratory
Primary
32
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32
LICENCIA DE LABORATORIO
PR
01
—
40D2036452
LICENCIA DE CLIA
PR
Enumeration date
10/26/2012
Last updated
10/26/2012
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