Provider Demographics
NPI:1487970984
Name:CENTRO RADIOLOGICO DE CAGUAS
Entity type:Organization
Organization Name:CENTRO RADIOLOGICO DE CAGUAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEVESA MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-342-9133
Mailing Address - Street 1:87 BIENTEVEO STREET
Mailing Address - Street 2:MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9534
Mailing Address - Country:US
Mailing Address - Phone:787-342-9133
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA
Practice Address - Street 2:PROFESSIONAL CENTER BUILDING SUITE 208
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14763261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588736169OtherNPI