Provider Demographics
NPI:1366589806
Name:DORADO X-RAY CENTER
Entity type:Organization
Organization Name:DORADO X-RAY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-796-5425
Mailing Address - Street 1:PO BOX 362338
Mailing Address - Street 2:SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2338
Mailing Address - Country:US
Mailing Address - Phone:787-796-5425
Mailing Address - Fax:787-796-5316
Practice Address - Street 1:410 CALLE MENDEZ VIGO
Practice Address - Street 2:SUITE 206-207
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4800
Practice Address - Country:US
Practice Address - Phone:787-796-5425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DORADO X-RAY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5793261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0215793OtherGLOBAL HEALTH PLAN
PR55793OtherCIGNA
PR20351OtherAMERICAN HEALTH PLAN
PR6460025OtherHUMANA INSURANCE
PR051709OtherCRUZ AZUL
PR30066OtherPMC
PR821522OtherMMM
PR83580OtherTRIPLE S
PR55793OtherCIGNA
PR=========OtherMEDICAL CARD SYSTEM
PR=========OtherSALUD DORADA
PR83580OtherTRIPLE S
PR83580OtherTRIPLE S