Healthcare Provider Details

I. General information

NPI: 1528595279
Provider Name (Legal Business Name): CARIBBEAN RADIOLOGY GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 INTERSECION 167, CONDOMINIO GALLARDO TOWERS OFICINA 101
BAYAMON PR
00961-6329
US

IV. Provider business mailing address

PO BOX 3049
BAYAMON PR
00960-3049
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-8034
  • Fax: 787-787-8029
Mailing address:
  • Phone: 787-785-8034
  • Fax: 787-787-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RICARDO DE JESUS GOMEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-785-8034