Provider Demographics
NPI:1134767148
Name:CENTRO RADIOLOGICO LAS PIEDRAS
Entity type:Organization
Organization Name:CENTRO RADIOLOGICO LAS PIEDRAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-733-5588
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:68 CALLE JOSE CELSO BARBOSA
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIBBEAN ROENTGEN GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty