Provider Demographics
NPI:1831318526
Name:CENTRO RADIOLOGICO DE MOCA
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO DE MOCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:ACEVEDO VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1787-833-3168
Mailing Address - Street 1:CENTRO RADIOLOGICO DE MOCA
Mailing Address - Street 2:CALLE JUAN SAN ANTONIO 207 EDIFICIO BOSQUES 12
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:178-783-3168
Mailing Address - Fax:787-265-3191
Practice Address - Street 1:CENTRO RADIOLOGICO DE MOCA
Practice Address - Street 2:CALLE JUAN SAN ANTONIO 207 EDIFICIO BOSQUES 12
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:178-783-3168
Practice Address - Fax:787-265-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology