Provider Demographics
NPI:1831302702
Name:CENTRO MEDICO DEL TURABO INC
Entity Type:Organization
Organization Name:CENTRO MEDICO DEL TURABO INC
Other - Org Name:GRUPO RADIOLOGIA BAYAMON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-653-3434
Mailing Address - Street 1:PO BOX 4980
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-653-3434
Mailing Address - Fax:787-961-1901
Practice Address - Street 1:HIMA SAN PABLO BAYAMON
Practice Address - Street 2:URB SANTA CRUZ 70 SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-620-4307
Practice Address - Fax:787-620-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9253OtherMEDICAL LICENSE
PR13018OtherMEDICAL LICENSE
PR15323OtherMEDICAL LICENSE
PR15893OtherMEDICAL LICENSE
PR11828OtherMEDICAL LICENSE
PR14743OtherMEDICAL LICENSE
PR13018OtherMEDICAL LICENSE