Provider Demographics
NPI:1992862528
Name:CENTRO TOMOGRAFICO DE PR INC
Entity Type:Organization
Organization Name:CENTRO TOMOGRAFICO DE PR INC
Other - Org Name:SOMASCAN CONDADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLODZIEJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-759-7878
Mailing Address - Street 1:PO BOX 364443
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4443
Mailing Address - Country:US
Mailing Address - Phone:787-721-7900
Mailing Address - Fax:787-756-8934
Practice Address - Street 1:1409 ASHFORD AVENUE CONDADO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-759-7878
Practice Address - Fax:787-756-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087834Medicare ID - Type Unspecified