Healthcare Provider Details

I. General information

NPI: 1558460311
Provider Name (Legal Business Name): CENTRO SONOGRAFICO DE ISABELA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CALLE EDUARDO QUEVEDO
ISABELA PR
00662-2617
US

IV. Provider business mailing address

PO BOX 2563
ISABELA PR
00662-2005
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-3332
  • Fax: 787-872-3332
Mailing address:
  • Phone: 787-872-3332
  • Fax: 787-872-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSIE MACHADO LOPEZ
Title or Position: OWNER
Credential: RDMS
Phone: 787-872-3332