=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366589806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DORADO X-RAY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 12/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 CALLE MENDEZ VIGO SUITE 206-207
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-796-5425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 362338 SAN JUAN
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-2338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-796-5425
-----------------------------------------------------
Fax | 787-796-5316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DUENO
-----------------------------------------------------
Name | MR. PABLO MORALES CARRASQUILLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-796-5425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | 5793
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------