Provider Demographics
NPI:1891927471
Name:CENTRO RADIOLOGICO CDT VILLA LOS SANTOS
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO CDT VILLA LOS SANTOS
Other - Org Name:CDT VILLA LOS SANTOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-817-3144
Mailing Address - Street 1:V1 CALLE 16
Mailing Address - Street 2:URB VILLA LOS SANTOS
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-3112
Mailing Address - Country:US
Mailing Address - Phone:787-817-3144
Mailing Address - Fax:787-879-4315
Practice Address - Street 1:V1 CALLE 16
Practice Address - Street 2:URB VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3112
Practice Address - Country:US
Practice Address - Phone:787-817-3144
Practice Address - Fax:787-879-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology