Healthcare Provider Details

I. General information

NPI: 1043221971
Provider Name (Legal Business Name): CENTRO IMAGENES DEL OESTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARINA STATION
MAYAGUEZ PR
00681-3089
US

IV. Provider business mailing address

PO BOX 3089 MARINA STATION
MAYAGUEZ PR
00681-3089
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-6868
  • Fax: 787-834-6888
Mailing address:
  • Phone: 787-834-6868
  • Fax: 787-834-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. ORESTES CASTELLANOS
Title or Position: CEO
Credential:
Phone: 787-834-6868