Provider Demographics
NPI:1952443186
Name:INTERNATIONAL RADIOLOGY CENTER & MEDICAL GROUP, PSC
Entity Type:Organization
Organization Name:INTERNATIONAL RADIOLOGY CENTER & MEDICAL GROUP, PSC
Other - Org Name:INTERNATIONAL RADIOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RADIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-529-8163
Mailing Address - Street 1:INTERNATIONAL MARKETING CENTER
Mailing Address - Street 2:SUITE C-107 1ST FL
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:UM
Mailing Address - Phone:787-529-8163
Mailing Address - Fax:
Practice Address - Street 1:INTERNATIONAL MARKETING CENTER
Practice Address - Street 2:SUITE C-107 1ST FL
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-529-8163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11391261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology