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General NPI Number Information
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NPI Number | 1225716715
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Entity Type | Organization
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Legal Business Name | CENTRO RADIODIAGNOSTICO DE CAROLINA LLC
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 10000 AVE 65 INFANTERIA CAROLINA SHOPPING COURT OFICINA 023A
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-257-0677
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Fax | 787-257-3030
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Provider Business Mailing Address
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Address Line | PO BOX 3049
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City | BAYAMON
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State | PR
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Zip | 00960-3049
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Country | US
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Telephone | 787-785-8034
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Fax | 787-787-8029
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS R MENDEZ BUSO
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Credential | MD
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Telephone | 787-785-8034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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