Provider Demographics
NPI:1548570211
Name:CENTRO RADIOLOGICO SHALOM INC
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO SHALOM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-501-5329
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1559
Mailing Address - Country:US
Mailing Address - Phone:787-501-5329
Mailing Address - Fax:787-280-1698
Practice Address - Street 1:CARR 2 KM101.6 BO TERRANVOVA
Practice Address - Street 2:MARGINAL DEL PARQUE
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-0000
Practice Address - Country:US
Practice Address - Phone:787-501-5329
Practice Address - Fax:787-280-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06-182335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier