Provider Demographics
NPI:1164851804
Name:CENTRO RADIOLOGICO DE LA MONTANA PSC
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO DE LA MONTANA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-630-2603
Mailing Address - Street 1:803 CARR KM 10.1
Mailing Address - Street 2:BO CEDRO ARRIBA
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9720
Mailing Address - Country:US
Mailing Address - Phone:787-869-2687
Mailing Address - Fax:787-869-0536
Practice Address - Street 1:HC 72 BOX 3951
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-8771
Practice Address - Country:US
Practice Address - Phone:787-869-2687
Practice Address - Fax:787-869-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography