Provider Demographics
NPI:1568583623
Name:CARDIOVASCULAR RADIOLOGY CENTRO
Entity Type:Organization
Organization Name:CARDIOVASCULAR RADIOLOGY CENTRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAUDIER GUERRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-727-0500
Mailing Address - Street 1:PO BOX 11792
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2892
Mailing Address - Country:US
Mailing Address - Phone:787-268-1015
Mailing Address - Fax:787-268-5511
Practice Address - Street 1:CENTRO CARDIOVASCULAR DE PR Y DEL CARIBE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-753-1765
Practice Address - Fax:787-771-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53402085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN NUMBER