Provider Demographics
NPI:1043221971
Name:CENTRO IMAGENES DEL OESTE
Entity Type:Organization
Organization Name:CENTRO IMAGENES DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ORESTES
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTELLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-6868
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3089
Mailing Address - Country:US
Mailing Address - Phone:787-834-6868
Mailing Address - Fax:787-834-6888
Practice Address - Street 1:MARINA STATION
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-3089
Practice Address - Country:US
Practice Address - Phone:787-834-6868
Practice Address - Fax:787-834-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherHUMANA GOLD PLUS
PR=========OtherTRICARE
PR=========OtherTRICARE