# LAZOS RADIOLOGY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720504814
- **Authorized official:** MRS. WILMA CORDERO GINES (MANAGER)
- **Authorized official phone:** (787) 727-0500

## Contact information

- **Practice address:** 611 CALLE MANUEL PAVIA, PAVIA MEDICAL PLAZA, SUITE 113, SAN JUAN, PR 00910
- **Practice address phone:** (787) 727-0500
- **Practice address fax:** (787) 268-5511
- **Mailing address:** PO BOX 11792, SAN JUAN, PR 00910-2892
- **Mailing address phone:** (787) 727-0500
- **Mailing address fax:** (787) 268-5511

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2471B0102X | Bone Densitometry Radiologic Technologist | — | NULL | — |
| 2471B0102X | Bone Densitometry Radiologic Technologist | — | — | — |
| 2471C3401X | Computed Tomography Radiologic Technologist | — | NULL | — |
| 2471C3401X | Computed Tomography Radiologic Technologist | — | — | — |
| 2471C3402X | Radiography Radiologic Technologist | — | NULL | — |
| 2471C3402X | Radiography Radiologic Technologist | — | — | — |
| 2471M2300X | Mammography Radiologic Technologist | — | NULL | Yes |
| 2471M2300X | Mammography Radiologic Technologist | — | — | Yes |
| 2471N0900X | Nuclear Medicine Technology Radiologic Technologist | — | NULL | — |
| 2471N0900X | Nuclear Medicine Technology Radiologic Technologist | — | — | — |
| 2471S1302X | Sonography Radiologic Technologist | — | NULL | — |
| 2471S1302X | Sonography Radiologic Technologist | — | — | — |
| 2471V0105X | Vascular Sonography Radiologic Technologist | — | NULL | — |
| 2471V0105X | Vascular Sonography Radiologic Technologist | — | — | — |

## Other

- **Enumeration date:** 08/21/2017
- **Last updated:** 08/21/2017