Provider Demographics
NPI:1700092400
Name:CENTRO RADIOLOGICO OAK PARK
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO OAK PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEGNOLOGA DE RAYOS X
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:920
Authorized Official - Phone:787-857-5836
Mailing Address - Street 1:CALLE BARCELO #8
Mailing Address - Street 2:#8
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-0988
Mailing Address - Country:US
Mailing Address - Phone:787-857-5836
Mailing Address - Fax:787-857-5836
Practice Address - Street 1:8 CALLE BARCELO
Practice Address - Street 2:#8
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1776
Practice Address - Country:US
Practice Address - Phone:787-857-5836
Practice Address - Fax:787-857-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
920261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology