Provider Demographics
NPI:1558352005
Name:CENTRO RADIOLOGICO ROLON INC
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO ROLON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEL VALLE BUGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-879-0750
Mailing Address - Street 1:PO BOX 142292
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2292
Mailing Address - Country:US
Mailing Address - Phone:787-879-0750
Mailing Address - Fax:787-879-0772
Practice Address - Street 1:HC 5 BOX 93652
Practice Address - Street 2:BARRIO HATO ARRIBA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9610
Practice Address - Country:US
Practice Address - Phone:787-879-0750
Practice Address - Fax:787-879-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084911OtherMEDICARE ID
0084911Medicare ID - Type Unspecified