Provider Demographics
NPI:1538324462
Name:NATIONAL ADVANCED DIAGNOSTIC IMAGING SUB-SPECIALISTS
Entity type:Organization
Organization Name:NATIONAL ADVANCED DIAGNOSTIC IMAGING SUB-SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-309-2266
Mailing Address - Street 1:URB LAS CUMBRES 497 EMILIANO POL
Mailing Address - Street 2:PMB 283
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5636
Mailing Address - Country:US
Mailing Address - Phone:816-309-2266
Mailing Address - Fax:787-283-1173
Practice Address - Street 1:URB LAS CUMBRES 497 EMILIANO POL
Practice Address - Street 2:PMB 283
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5636
Practice Address - Country:US
Practice Address - Phone:816-309-2266
Practice Address - Fax:787-283-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty