Provider Demographics
NPI:1053433896
Name:CENTRO RADIOLOGICO DEL OESTE
Entity type:Organization
Organization Name:CENTRO RADIOLOGICO DEL OESTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:O
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-3168
Mailing Address - Street 1:CALLE PERAL NORTE #17N
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-833-3168
Mailing Address - Fax:787-265-3191
Practice Address - Street 1:CALLE PERAL #17N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-3168
Practice Address - Fax:787-265-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5377PR2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
26877Medicare ID - Type Unspecified