Provider Demographics
NPI:1073612826
Name:CENTRO RADIODIAGNOSTICO CAROLINA
Entity Type:Organization
Organization Name:CENTRO RADIODIAGNOSTICO CAROLINA
Other - Org Name:CENTRO RADIODIAGNOSTICO DE CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-762-8216
Mailing Address - Street 1:PO BOX 7037
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-7037
Mailing Address - Country:US
Mailing Address - Phone:787-762-8216
Mailing Address - Fax:787-257-3030
Practice Address - Street 1:CAROLINA SHOPPING COURT
Practice Address - Street 2:SUITE 023A CAROLINA CT & BREAST CLINIC
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-257-0677
Practice Address - Fax:787-257-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0024135Medicare PIN