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General NPI Number Information
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NPI Number | 1629470158
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Entity Type | Organization
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Legal Business Name | CENTRO DE RADIOLOGIA INTERVENCIONAL DE PUERTO RICO CP
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 1760 CALLE LOIZA STE 205
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City | SANTURCE
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State | PR
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Zip | 00911
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Country | US
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Telephone | 787-758-3320
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Fax | 787-758-3358
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Provider Business Mailing Address
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Address Line | 660 CALLE ESTADO APT A
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City | SAN JUAN
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State | PR
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Zip | 00907-3533
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Country | US
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Telephone | 305-297-4377
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Fax | 888-350-0180
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN IGNACIO GORROCHATEGUI
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Credential | M.D.
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Telephone | 305-297-4377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 17366
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License Number State | PR
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