Provider Demographics
NPI:1215925870
Name:CENTRO RADIOLOGICO DE ISABELA
Entity type:Organization
Organization Name:CENTRO RADIOLOGICO DE ISABELA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-872-4888
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0946
Mailing Address - Country:US
Mailing Address - Phone:787-872-4888
Mailing Address - Fax:787-872-8181
Practice Address - Street 1:4 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3006
Practice Address - Country:US
Practice Address - Phone:787-872-4888
Practice Address - Fax:787-872-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR511367OtherPREFERRED HEALTH
PR810098OtherMMM
PR30008OtherPREFERRED MEDICARE CHOICE
PR6620071OtherHUMANA INSURANCE
PRA005OtherINTERNATIONAL MEDICAL CAR
PRRX0228OtherPALIC PROVIDER
PR100710OtherLA CRUZ AZUL DE P.R.
PR=========OtherCOSVI
PRRX0228OtherPALIC PROVIDER
PR100710OtherLA CRUZ AZUL DE P.R.
PR511367OtherPREFERRED HEALTH