Provider Demographics
NPI:1538106893
Name:GILBERTO VAZQUEZ PEREZ
Entity Type:Organization
Organization Name:GILBERTO VAZQUEZ PEREZ
Other - Org Name:CENTRO RADIOLOGICO DE LA MONTANA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-869-2687
Mailing Address - Street 1:HC 72 BOX 3951
Mailing Address - Street 2:
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:CARRETERA 152 INTERSECCION 803
Practice Address - Street 2:BO CEDRO ARRIBA
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-9720
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:2006-06-02
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
X000230OtherMENONITA
511199OtherPREFERRED HEALTH
660506074OtherMAPFRE
810039OtherMEDICARE Y MUCHO MAS
85042OtherTRIPLE S
85042OtherTRIPLE C
051722OtherCRUZ AZUL
7190123OtherHUMANA INSURANCE
1143OtherINTERNATIONAL MEDICAL CAR
660506074OtherCIGNA
7190123OtherHUMANA REFORMA
7190123OtherHUMANA HEALTH PLAN
RX0125OtherPALIC
660506074OtherCIGNA
7190123OtherHUMANA INSURANCE
810039OtherMEDICARE Y MUCHO MAS
=========OtherAMERICAN HEALTH
=========OtherPROSAAM