Provider Demographics
NPI:1720075120
Name:MONSERRATE IMAGING CENTER PSC
Entity Type:Organization
Organization Name:MONSERRATE IMAGING CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALSALOBRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-381-5091
Mailing Address - Street 1:PARQUE DE ORIENTE #79 PASEO PARQUE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-755-3099
Mailing Address - Fax:787-748-7701
Practice Address - Street 1:AVENIDA MONSERRA BA 25
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-381-5091
Practice Address - Fax:787-762-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085B0100X
PR02522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
84846Medicare ID - Type Unspecified