Provider Demographics
NPI:1629470158
Name:CENTRO DE RADIOLOGIA INTERVENCIONAL DE PUERTO RICO CP
Entity Type:Organization
Organization Name:CENTRO DE RADIOLOGIA INTERVENCIONAL DE PUERTO RICO CP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:GORROCHATEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-297-4377
Mailing Address - Street 1:660 CALLE ESTADO APT A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3533
Mailing Address - Country:US
Mailing Address - Phone:305-297-4377
Mailing Address - Fax:888-350-0180
Practice Address - Street 1:1760 CALLE LOIZA STE 205
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00911
Practice Address - Country:US
Practice Address - Phone:787-758-3320
Practice Address - Fax:787-758-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR173662085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty