Provider Demographics
NPI:1902804545
Name:SAN SEBASTIAN X RAY
Entity Type:Organization
Organization Name:SAN SEBASTIAN X RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSA QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-280-0981
Mailing Address - Street 1:PO BOX 3144
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7003
Mailing Address - Country:US
Mailing Address - Phone:787-280-0981
Mailing Address - Fax:787-280-0984
Practice Address - Street 1:CARR 111 KM 18.0 BIO MAHOMAMEY
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-0981
Practice Address - Fax:787-280-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2323212471M2300X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022069Medicare PIN