{"id":10225,"date":"2025-07-30T11:45:20","date_gmt":"2025-07-30T16:45:20","guid":{"rendered":"https:\/\/cmdnmollendo.com\/?page_id=10225"},"modified":"2025-09-10T10:51:35","modified_gmt":"2025-09-10T15:51:35","slug":"formulario","status":"publish","type":"page","link":"https:\/\/cmdnmollendo.com\/index.php\/formulario\/","title":{"rendered":"FORMULARIO"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"10225\" class=\"elementor elementor-10225\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-157a0b1 e-flex e-con-boxed e-con e-parent\" data-id=\"157a0b1\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-39e43fb elementor-widget elementor-widget-shortcode\" data-id=\"39e43fb\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f10346-o1\" lang=\"es-PE\" dir=\"ltr\" data-wpcf7-id=\"10346\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/10225#wpcf7-f10346-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"10346\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_PE\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f10346-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p>Para poder ofrecer su cotizaci\u00f3n formal por favor proveer los siguientes datos de su empresa:\n<\/p>\n<p><label> RUC:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ruc\"><input size=\"40\" maxlength=\"11\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"RUC\" value=\"\" type=\"tel\" name=\"ruc\" \/><\/span><\/label><br \/>\n<label> Raz\u00f3n Social:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-737\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Raz\u00f3n Social\" value=\"\" type=\"text\" name=\"text-737\" \/><\/span><\/label><br \/>\n<label> Rubro de la Empresa:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-181\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Rubro de la Empresa\" value=\"\" type=\"text\" name=\"text-181\" \/><\/span><\/label>\n<\/p>\n<p>Asi como los datos de la persona que ser\u00e1 el contacto para estas coordinaciones:\n<\/p>\n<p><label> Nombre:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Nombre\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label><br \/>\n<label> Correo Electr\u00f3nico:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Correo Electr\u00f3nico\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label><br \/>\n<label> Tel\u00e9fono:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-700\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Tel\u00e9fono\" value=\"\" type=\"tel\" name=\"tel-700\" \/><\/span> <\/label>\n<\/p>\n<p>En caso de contar con \u00e1rea medica ocupacional, favor de remitir el:\n<\/p>\n<p><label> Nombre:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-392\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Nombre\" value=\"\" type=\"text\" name=\"text-392\" \/><\/span> <\/label><br \/>\n<label> Colegiatura:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-774\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Colegiatura\" value=\"\" type=\"text\" name=\"text-774\" \/><\/span> <\/label><br \/>\n<label> Correo del Medico y\/o Enfermera:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-586\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" placeholder=\"Correo del Medico y\/o Enfermera\" value=\"\" type=\"email\" name=\"email-586\" \/><\/span> <\/label>\n<\/p>\n<center>\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Enviar Mensaje\" \/>\n\t<\/p>\n<\/center><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-10225","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>FORMULARIO - Centro Medico Divino Ni\u00f1o Mollendo<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cmdnmollendo.com\/index.php\/formulario\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"FORMULARIO - Centro 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