Healthcare Provider Details

I. General information

NPI: 1629295431
Provider Name (Legal Business Name): CARIBBEAN ROENTGEN GROUP,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

# 68 CALLE DR. JUSE CELSO BARBOSA
LAS PIEDRAS PR
00771
US

IV. Provider business mailing address

PO BOX 1043
LAS PIEDRAS PR
00771-1043
US

V. Phone/Fax

Practice location:
  • Phone: 787-733-5588
  • Fax: 787-733-5588
Mailing address:
  • Phone: 787-733-5588
  • Fax: 787-733-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number7078
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number7078
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number7078
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number7078
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number7078
License Number StatePR

VIII. Authorized Official

Name: DR. GLADIMIRO DAVILA-MARTINEZ
Title or Position: RADIOLOGIST
Credential: M.D.
Phone: 787-733-5588