Provider Demographics
NPI:1902258031
Name:TOA ALTA X-RAY & IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:TOA ALTA X-RAY & IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-998-5055
Mailing Address - Street 1:PO BOX 364964
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4964
Mailing Address - Country:US
Mailing Address - Phone:787-998-5055
Mailing Address - Fax:787-870-8300
Practice Address - Street 1:9 CALLE ANTONIO R BARCELO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2444
Practice Address - Country:US
Practice Address - Phone:787-998-5055
Practice Address - Fax:787-870-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography