1902123193 NPI number — CENTRO RADIOLOGICO DE YABUCOA, INC.

Table of content: (NPI 1902123193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902123193 NPI number — CENTRO RADIOLOGICO DE YABUCOA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO RADIOLOGICO DE YABUCOA, INC.
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:
1902123193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9132
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMACAO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00792-9132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-852-0920
Provider Business Mailing Address Fax Number:
787-285-4468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZA YABUCOA # 901
Provider Second Line Business Practice Location Address:
KM13.1, LOTE 5, BO. JUAN MARTIN
Provider Business Practice Location Address City Name:
YABUCOA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00767-3338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-266-0930
Provider Business Practice Location Address Fax Number:
787-266-3244
Provider Enumeration Date:
04/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NASSAR
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-852-0920

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  2993 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 87887 . This is a "MEDICARE ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 87836 . This is a "MEDICARE ID-HOSP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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