1144233305 NPI number — CENTRO RADIOLOGICO LUQUILLO PSC

Table of content: (NPI 1144233305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144233305 NPI number — CENTRO RADIOLOGICO LUQUILLO PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO RADIOLOGICO LUQUILLO PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144233305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB SUITE 418
Provider Second Line Business Mailing Address:
CALL BOX 20,000
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-889-2483
Provider Business Mailing Address Fax Number:
787-889-0432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 193 KM 1 LOCAL 5
Provider Second Line Business Practice Location Address:
PLAYA AZUL CENTER
Provider Business Practice Location Address City Name:
LUQUILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-889-2483
Provider Business Practice Location Address Fax Number:
787-889-0432
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENCI RESA
Authorized Official First Name:
SONIA
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PROPIETARIA
Authorized Official Telephone Number:
787-889-2483

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051954 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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