Provider Demographics
NPI:1902123193
Name:CENTRO RADIOLOGICO DE YABUCOA, INC.
Entity Type:Organization
Organization Name:CENTRO RADIOLOGICO DE YABUCOA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-852-0920
Mailing Address - Street 1:PO BOX 9132
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9132
Mailing Address - Country:US
Mailing Address - Phone:787-852-0920
Mailing Address - Fax:787-285-4468
Practice Address - Street 1:PLAZA YABUCOA # 901
Practice Address - Street 2:KM13.1, LOTE 5, BO. JUAN MARTIN
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3338
Practice Address - Country:US
Practice Address - Phone:787-266-0930
Practice Address - Fax:787-266-3244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. JOSE A. NASSAR & ASOCIADOS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2993261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87887OtherMEDICARE ID
PR87836OtherMEDICARE ID-HOSP