Healthcare Provider Details

I. General information

NPI: 1538486998
Provider Name (Legal Business Name): CENTRO RADIOLOGICO DE HUMACAO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CALLE CRUZ ORTIZ STELLA S
HUMACAO PR
00791-4180
US

IV. Provider business mailing address

PO BOX 9132
HUMACAO PR
00792-9132
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0920
  • Fax: 787-285-4468
Mailing address:
  • Phone: 787-852-0920
  • Fax: 787-285-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number12672
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number2993
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number2993
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE A NASSAR
Title or Position: PRESIDENT
Credential: MD
Phone: 787-852-0920