Healthcare Provider Details

I. General information

NPI: 1801119805
Provider Name (Legal Business Name): SOCIEDAD DE RADIOLOGOS ISABELINOS,P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL BUEN SAMARITANO DEPARTAMENTO DE RADIOLOGIA-OFICINA DE RADIOLOGOS
AGUADILLA PR
00603-0000
US

IV. Provider business mailing address

PO BOX 845
MANATI PR
00674-0845
US

V. Phone/Fax

Practice location:
  • Phone: 787-624-0200
  • Fax: 787-658-0612
Mailing address:
  • Phone: 787-854-3131
  • Fax: 787-854-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4836
License Number StatePR

VIII. Authorized Official

Name: DR. FRANCISCO DE LA CRUZ-CRUZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-854-3131