Provider Demographics
NPI:1144233305
Name:CENTRO RADIOLOGICO LUQUILLO PSC
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO LUQUILLO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIA
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:JIMENCI RESA
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:787-889-2483
Mailing Address - Street 1:PMB SUITE 418
Mailing Address - Street 2:CALL BOX 20,000
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-889-2483
Mailing Address - Fax:787-889-0432
Practice Address - Street 1:CARR. 193 KM 1 LOCAL 5
Practice Address - Street 2:PLAYA AZUL CENTER
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-889-2483
Practice Address - Fax:787-889-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR051954OtherCRUZ AZUL
PR=========OtherKRMM