1710202882 NPI number — JESUS ROMERO PEREZ

Table of content: (NPI 1710202882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710202882 NPI number — JESUS ROMERO PEREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESUS ROMERO PEREZ
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:
ADVANCED RADIOLOGY CENTERS
Provider Other Organization Name Type Code:
3
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:
1710202882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-4129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-832-3630
Provider Business Mailing Address Fax Number:
787-832-3530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 CALLE PABLO MAIZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-4840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-832-3630
Provider Business Practice Location Address Fax Number:
787-832-3530
Provider Enumeration Date:
04/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROMERO PEREZ
Authorized Official First Name:
JESUS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-464-3947

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  11722 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X , with the licence number: 11722 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0206X , with the licence number: 11722 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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