Healthcare Provider Details

I. General information

NPI: 1164636940
Provider Name (Legal Business Name): CENTRO RADIOLOGICO Y ULTRASONIDO COMERIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 778 KM 0.9 BO PASARELL
COMERIO PR
00782
US

IV. Provider business mailing address

PO BOX 1103
COMERIO PR
00782-1103
US

V. Phone/Fax

Practice location:
  • Phone: 787-875-3136
  • Fax: 787-875-4904
Mailing address:
  • Phone: 787-875-3136
  • Fax: 787-875-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS M GONZALEZ BERMUDEZ
Title or Position: PRESIDENTE
Credential: DM
Phone: 787-875-3136