Provider Demographics
NPI:1619939261
Name:HDT CORP
Entity type:Organization
Organization Name:HDT CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AINEX
Authorized Official - Middle Name:N
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-362-6586
Mailing Address - Street 1:15 CALLE BETANCES
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5051
Mailing Address - Country:US
Mailing Address - Phone:787-891-3953
Mailing Address - Fax:787-891-3953
Practice Address - Street 1:15 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5051
Practice Address - Country:US
Practice Address - Phone:787-891-3953
Practice Address - Fax:787-891-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR467291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038335Medicare ID - Type Unspecified