Provider Demographics
NPI:1063468379
Name:CORPORACION ORTIZ NEGRON CENTRO RADIOLOGICO COROZAL
Entity Type:Organization
Organization Name:CORPORACION ORTIZ NEGRON CENTRO RADIOLOGICO COROZAL
Other - Org Name:CENTRO RADIOLOGICO SONOGRAFICO DIGITAL COROZAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMARILYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-802-1260
Mailing Address - Street 1:14 CALLE GANDARA
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-2057
Mailing Address - Country:US
Mailing Address - Phone:787-802-1260
Mailing Address - Fax:787-802-1795
Practice Address - Street 1:14 CALLE GANDARA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2057
Practice Address - Country:US
Practice Address - Phone:787-802-1260
Practice Address - Fax:787-802-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Multi-Specialty
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058538Medicare PIN