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General NPI Number Information
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NPI Number | 1134767148
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Entity Type | Organization
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Legal Business Name | CENTRO RADIOLOGICO LAS PIEDRAS
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Dates
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Enumeration Date | 12/20/2019
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 68 CALLE JOSE CELSO BARBOSA
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City | LAS PIEDRAS
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State | PR
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Zip | 00771
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Country | US
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Telephone | 787-733-5588
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1043
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City | LAS PIEDRAS
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State | PR
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Zip | 00771
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRADORA
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Name | ASTRID DAVILA DIAZ
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Credential |
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Telephone | 787-733-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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