Provider Demographics
NPI:1700119427
Name:CENTRO RADIOLOGICO ALONDRA
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO ALONDRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:BERGANZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-533-0586
Mailing Address - Street 1:PO BOX 1302
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1302
Mailing Address - Country:US
Mailing Address - Phone:787-533-0586
Mailing Address - Fax:
Practice Address - Street 1:KM 28.1
Practice Address - Street 2:BARRIO ESPINOZA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-533-0586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology