Provider Demographics
NPI:1114263118
Name:EL SENORIAL CENTRO DE IMAGENES, LLC
Entity Type:Organization
Organization Name:EL SENORIAL CENTRO DE IMAGENES, LLC
Other - Org Name:SAME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERDOMO FERRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-764-9493
Mailing Address - Street 1:PO BOX 367862
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7862
Mailing Address - Country:US
Mailing Address - Phone:787-764-9493
Mailing Address - Fax:787-759-3621
Practice Address - Street 1:1755 CALLE PARANA
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-6030
Practice Address - Country:US
Practice Address - Phone:787-764-9493
Practice Address - Fax:787-759-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty