Provider Demographics
NPI:1629295431
Name:CARIBBEAN ROENTGEN GROUP,INC.
Entity Type:Organization
Organization Name:CARIBBEAN ROENTGEN GROUP,INC.
Other - Org Name:GLADIMIRO DAVILA-MARTINEZ,M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADIMIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-733-5588
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1043
Mailing Address - Country:US
Mailing Address - Phone:787-733-5588
Mailing Address - Fax:787-733-5588
Practice Address - Street 1:# 68 CALLE DR. JUSE CELSO BARBOSA
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-5588
Practice Address - Fax:787-733-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR70782085B0100X, 2085P0229X, 2085R0205X, 2085U0001X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological PhysicsGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7078OtherPUERTO RICO MEDICAL LICENCE
PR7078OtherPUERTO RICO MEDICAL LICENCE