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General NPI Number Information
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NPI Number | 1801119805
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Entity Type | Organization
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Legal Business Name | SOCIEDAD DE RADIOLOGOS ISABELINOS,P.S.C.
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | HOSPITAL BUEN SAMARITANO DEPARTAMENTO DE RADIOLOGIA-OFICINA DE RADIOLOGOS
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City | AGUADILLA
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State | PR
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Zip | 00603-0000
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Country | US
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Telephone | 787-624-0200
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Fax | 787-658-0612
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Provider Business Mailing Address
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Address Line | PO BOX 845
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City | MANATI
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State | PR
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Zip | 00674-0845
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Country | US
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Telephone | 787-854-3131
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Fax | 787-854-3235
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANCISCO DE LA CRUZ-CRUZ
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Credential | M.D.
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Telephone | 787-854-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4836
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License Number State | PR
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