Provider Demographics
NPI:1073848958
Name:GRUPO RADIOLOGICO DEL CENTRO
Entity Type:Organization
Organization Name:GRUPO RADIOLOGICO DEL CENTRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-857-3989
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-0429
Mailing Address - Country:US
Mailing Address - Phone:787-857-3900
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE HERMANDAD
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1730
Practice Address - Country:US
Practice Address - Phone:787-857-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1254261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography