Healthcare Provider Details

I. General information

NPI: 1871875260
Provider Name (Legal Business Name): CARLOS I LLORENS-MARIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE 2ND FLOOR RADIOLOGY CHP
PITTSBURGH PA
15224
US

IV. Provider business mailing address

RADIOLOGIA RCM PO BOX 29134
SAN JUAN PR
00929-0134
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5032
  • Fax:
Mailing address:
  • Phone: 787-474-0333
  • Fax: 787-777-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMT210198
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number19366
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number19366
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number19366
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: