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General NPI Number Information
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NPI Number | 1326357088
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Entity Type | Organization
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Legal Business Name | CENTRO IMAGEN
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | CARR 115 BO PUEBLO
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City | RINCON
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State | PR
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Zip | 00677
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Country | US
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Telephone | 787-823-0909
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Fax | 787-823-0904
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | VEGA ALTA
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State | PR
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Zip | 00692-0419
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Country | US
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Telephone | 787-270-3330
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Fax | 787-270-3335
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS M GONZALEZ
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Credential | MD
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Telephone | 787-270-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 98
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License Number State | PR
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