Healthcare Provider Details

I. General information

NPI: 1962442715
Provider Name (Legal Business Name): CASTELLANA X RAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMPO RICO A-6 CASTELLANA GARDENS
CAROLINA PR
00984-1948
US

IV. Provider business mailing address

PO BOX 1948
CAROLINA PR
00984-1948
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-8245
  • Fax: 787-768-0689
Mailing address:
  • Phone: 787-769-8245
  • Fax: 787-768-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS RODRIGUEZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 787-763-8245