Provider Demographics
NPI:1124228838
Name:SANTA ROSA OPEN MRI & CT CENTER
Entity type:Organization
Organization Name:SANTA ROSA OPEN MRI & CT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALDUONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-596-1118
Mailing Address - Street 1:AVE MAIN BLQ 51
Mailing Address - Street 2:#39
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-708-5000
Mailing Address - Fax:
Practice Address - Street 1:AVE MAIN SANTA ROSA
Practice Address - Street 2:BLQ 51 #39
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-708-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0703041261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0703041OtherCNC PERMIT FOR FACILITY