Provider Demographics
NPI:1619027109
Name:XRAYCDTPOLICLINICAFAMILIARFACTOR
Entity Type:Organization
Organization Name:XRAYCDTPOLICLINICAFAMILIARFACTOR
Other - Org Name:POLICLINICA DE FAMILIA FACTOR INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRUNILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-881-2953
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0970
Mailing Address - Country:US
Mailing Address - Phone:787-881-2953
Mailing Address - Fax:787-881-4807
Practice Address - Street 1:# 2 CARR. KM 65.6
Practice Address - Street 2:BO. FACTOR 1
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-881-2953
Practice Address - Fax:787-881-4807
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLICLINICA DE FAMILIA FACTOR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology