Provider Demographics
NPI:1154630812
Name:CENTRO IMAGEN
Entity Type:Organization
Organization Name:CENTRO IMAGEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-270-4747
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0356
Mailing Address - Country:US
Mailing Address - Phone:787-270-4747
Mailing Address - Fax:787-270-4747
Practice Address - Street 1:CARR 693 SUITE 172
Practice Address - Street 2:BO BRENAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-4747
Practice Address - Fax:787-270-4747
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELORUM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology