Provider Demographics
NPI:1912437112
Name:CENTRO RADIOLOGICO CT SCAN & MRI
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO CT SCAN & MRI
Other - Org Name:JORGE L TORRES NAZARIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-844-1614
Mailing Address - Street 1:8169 CONCORDIA STREET SUITE 1
Mailing Address - Street 2:CONDOMINIO SAN VICENTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1555
Mailing Address - Country:US
Mailing Address - Phone:787-844-8510
Mailing Address - Fax:787-813-2779
Practice Address - Street 1:4057 CALLE AURORA STE 1
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1523
Practice Address - Country:US
Practice Address - Phone:787-844-1614
Practice Address - Fax:787-813-2779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGOS DEL SUR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9822261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid