Provider Demographics
NPI:1508758525
Name:CENTRO DE DIAGNOSTICO PARA INTELIGENCIAS MULTIPLES
Entity type:Organization
Organization Name:CENTRO DE DIAGNOSTICO PARA INTELIGENCIAS MULTIPLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:
Authorized Official - First Name:IDELIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-722-9595
Mailing Address - Street 1:PO BOX 9023879
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3879
Mailing Address - Country:US
Mailing Address - Phone:787-722-9595
Mailing Address - Fax:
Practice Address - Street 1:CALLE VICTORIA 1551
Practice Address - Street 2:SANTURCE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-722-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty