Provider Demographics
NPI:1417395450
Name:CENTRO DE IMAGENES RIO HONDO
Entity Type:Organization
Organization Name:CENTRO DE IMAGENES RIO HONDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-261-2140
Mailing Address - Street 1:AVE RIO HONDO
Mailing Address - Street 2:PMB SUITE 187 #90
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3100
Mailing Address - Country:US
Mailing Address - Phone:787-261-2140
Mailing Address - Fax:787-261-3422
Practice Address - Street 1:CENTRO COMERCIAL PLAZA RIO HONDO
Practice Address - Street 2:LOCAL 3R SUITE 201
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-261-2140
Practice Address - Fax:787-261-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0099628Medicare PIN