Healthcare Provider Details

I. General information

NPI: 1396723490
Provider Name (Legal Business Name): CENTRO DE IMAGENES SONOGRAFICAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA BUXO LOCAL 4B CARR 181 INT 183
SAN LORENZO PR
00754
US

IV. Provider business mailing address

HC 20 BOX 29194
SAN LORENZO PR
00754-9634
US

V. Phone/Fax

Practice location:
  • Phone: 787-736-0980
  • Fax: 787-736-4226
Mailing address:
  • Phone: 787-736-0980
  • Fax: 787-736-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number23180
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23180
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number23180
License Number StatePR

VIII. Authorized Official

Name: LUIS F VARGAS SR.
Title or Position: DOCTOR PRESIDENT
Credential: MD
Phone: 787-736-0980