Provider Demographics
NPI:1992925804
Name:CARIBBEAN NEURORADIOLOGY SERVICES, INC.
Entity type:Organization
Organization Name:CARIBBEAN NEURORADIOLOGY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-841-1730
Mailing Address - Street 1:2053 PONCE BYP
Mailing Address - Street 2:CENTRO CARIBE BUILDING 103
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1306
Mailing Address - Country:US
Mailing Address - Phone:787-841-1730
Mailing Address - Fax:787-841-1725
Practice Address - Street 1:2053 PONCE BYP
Practice Address - Street 2:CENTRO CARIBE BUILDING 103
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1306
Practice Address - Country:US
Practice Address - Phone:787-841-1730
Practice Address - Fax:787-841-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7465261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC83167Medicare UPIN