Healthcare Provider Details

I. General information

NPI: 1467933317
Provider Name (Legal Business Name): LOIZA VALLEY MR & CT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 01/26/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOIZA VALLEY SHOPPING CENTER LOCAL AA4
CANOVANAS PR
00729
US

IV. Provider business mailing address

4AA CALLE BAHUINIA URB. LOIZA VALLEY
CANOVANAS PR
00729-3551
US

V. Phone/Fax

Practice location:
  • Phone: 787-954-9389
  • Fax:
Mailing address:
  • Phone: 787-945-0328
  • Fax: 786-364-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS CRISTINA M. ALVAREZ RODRIGUEZ
Title or Position: MANAGER
Credential: BA
Phone: 787-954-9389