Provider Demographics
NPI:1023152162
Name:RADIOLOGIA CENTRO SALUD MARIO CANALES
Entity type:Organization
Organization Name:RADIOLOGIA CENTRO SALUD MARIO CANALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:ZAMORA
Authorized Official - Last Name:AMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-828-0259
Mailing Address - Street 1:2 CALLE CENTERIO
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664
Mailing Address - Country:US
Mailing Address - Phone:787-282-0259
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE CENTERIO
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-282-0259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR003142Medicare ID - Type Unspecified