=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912437112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRO RADIOLOGICO CT SCAN & MRI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2017
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4057 CALLE AURORA STE 1
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-1523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-1614
-----------------------------------------------------
Fax | 787-813-2779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8169 CONCORDIA STREET SUITE 1 CONDOMINIO SAN VICENTE
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-1555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-8510
-----------------------------------------------------
Fax | 787-813-2779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JORGE L TORRES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-844-1614
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | 9822
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------