1215925870 NPI number — CENTRO RADIOLOGICO DE ISABELA

Table of content: (NPI 1215925870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215925870 NPI number — CENTRO RADIOLOGICO DE ISABELA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO RADIOLOGICO DE ISABELA
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:
1215925870
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:
PO BOX 946
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-0946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-872-4888
Provider Business Mailing Address Fax Number:
787-872-8181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 CALLE MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-872-4888
Provider Business Practice Location Address Fax Number:
787-872-8181
Provider Enumeration Date:
10/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ-SANTIAGO
Authorized Official First Name:
GILBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MEDICAL SUPERVISOR
Authorized Official Telephone Number:
787-872-4888

Provider Taxonomy Codes

  • Taxonomy code: 261QR0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 511367 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 810098 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30008 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6620071 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: A005 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: RX0228 . This is a "PALIC PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 100710 . This is a "LA CRUZ AZUL DE P.R." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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