Provider Demographics
NPI:1760955033
Name:EM MARIO CANALES TORRESOLA
Entity Type:Organization
Organization Name:EM MARIO CANALES TORRESOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MORALES TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-677-4626
Mailing Address - Street 1:PO BOX 1346
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-2346
Mailing Address - Country:US
Mailing Address - Phone:787-677-4626
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE ROSANTA AULET
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1328
Practice Address - Country:US
Practice Address - Phone:787-677-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EM MARIO CANALES TORRESOLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty