Provider Demographics
NPI:1326043118
Name:CENTRO IMAGENES DE MANATI PSC
Entity Type:Organization
Organization Name:CENTRO IMAGENES DE MANATI PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-854-1818
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-1818
Mailing Address - Fax:787-854-8524
Practice Address - Street 1:CALLE MARGINAL B 1
Practice Address - Street 2:URB SAN SALVADOR
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1818
Practice Address - Fax:787-854-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0110382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20955Medicare PIN
PR21019Medicare PIN
PRF41776Medicare UPIN
PR82204Medicare PIN