1629470158 NPI number — CENTRO DE RADIOLOGIA INTERVENCIONAL DE PUERTO RICO CP

Table of content: (NPI 1629470158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629470158 NPI number — CENTRO DE RADIOLOGIA INTERVENCIONAL DE PUERTO RICO CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE RADIOLOGIA INTERVENCIONAL DE PUERTO RICO CP
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:
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Provider Other Middle Name:
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NPI Number Information

NPI Number:
1629470158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 CALLE ESTADO APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907-3533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-297-4377
Provider Business Mailing Address Fax Number:
888-350-0180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1760 CALLE LOIZA STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-3320
Provider Business Practice Location Address Fax Number:
787-758-3358
Provider Enumeration Date:
09/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GORROCHATEGUI
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
IGNACIO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-297-4377

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  17366 , 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)





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