1912437112 NPI number — CENTRO RADIOLOGICO CT SCAN & MRI

Table of content: (NPI 1912437112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912437112 NPI number — CENTRO RADIOLOGICO CT SCAN & MRI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO RADIOLOGICO CT SCAN & MRI
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:
6
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:
1912437112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8169 CONCORDIA STREET SUITE 1
Provider Second Line Business Mailing Address:
CONDOMINIO SAN VICENTE
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00717-1555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-844-8510
Provider Business Mailing Address Fax Number:
787-813-2779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4057 CALLE AURORA STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-844-1614
Provider Business Practice Location Address Fax Number:
787-813-2779
Provider Enumeration Date:
06/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-844-1614

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  9822 , 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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