Provider Demographics
NPI:1669866398
Name:METRO PAVIA HEALTHCARE CENTERS INC
Entity Type:Organization
Organization Name:METRO PAVIA HEALTHCARE CENTERS INC
Other - Org Name:METRO PAVIA CLINIC CAROLINA XR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-772-9850
Mailing Address - Street 1:400 CALLE CALAF PMB 455
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-772-9850
Mailing Address - Fax:787-274-8895
Practice Address - Street 1:CARR 857 KM 13.4
Practice Address - Street 2:BO CANOVANILLAS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-772-9850
Practice Address - Fax:787-274-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR241967261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography