Provider Demographics
NPI:1083938625
Name:JESUS ROMERO PEREZ
Entity Type:Organization
Organization Name:JESUS ROMERO PEREZ
Other - Org Name:ADVANCED RADIOLOGY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE PRES
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-464-3947
Mailing Address - Street 1:PO BOX 4129
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-4129
Mailing Address - Country:US
Mailing Address - Phone:787-255-0680
Mailing Address - Fax:787-255-0666
Practice Address - Street 1:87 CALLE CARBONELL
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3443
Practice Address - Country:US
Practice Address - Phone:787-255-0680
Practice Address - Fax:787-255-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11722261QM1200X, 261QR0200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG57831Medicare UPIN
PR0088555Medicare PIN