Healthcare Provider Details

I. General information

NPI: 1982913646
Provider Name (Legal Business Name): CENTRO DE IMAGEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR # 2 KM. 31.9 BO BAJURA
VEGA ALTA PR
00692
US

IV. Provider business mailing address

PO BOX 419
VEGA ALTA PR
00692-0419
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-3330
  • Fax: 787-270-3335
Mailing address:
  • Phone: 787-270-3330
  • Fax: 787-270-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number62
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS M GONZALEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-270-3330