Healthcare Provider Details

I. General information

NPI: 1134767148
Provider Name (Legal Business Name): CENTRO RADIOLOGICO LAS PIEDRAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE JOSE CELSO BARBOSA
LAS PIEDRAS PR
00771
US

IV. Provider business mailing address

PO BOX 1043
LAS PIEDRAS PR
00771
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: ASTRID DAVILA DIAZ
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-733-5588