Healthcare Provider Details

I. General information

NPI: 1558352005
Provider Name (Legal Business Name): CENTRO RADIOLOGICO ROLON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 5 BOX 93652 BARRIO HATO ARRIBA
ARECIBO PR
00612-9610
US

IV. Provider business mailing address

PO BOX 142292
ARECIBO PR
00614-2292
US

V. Phone/Fax

Practice location:
  • Phone: 787-879-0750
  • Fax: 787-879-0772
Mailing address:
  • Phone: 787-879-0750
  • Fax: 787-879-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CESAR A DEL VALLE BUGUE
Title or Position: OWNER
Credential:
Phone: 787-879-0750