Provider Demographics
NPI:1649305137
Name:RADIOLOGIA & SONOGRAFIA DE GUAYNABO
Entity type:Organization
Organization Name:RADIOLOGIA & SONOGRAFIA DE GUAYNABO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:NYDIA
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-272-5656
Mailing Address - Street 1:53 AVE ESMERALDA
Mailing Address - Street 2:PMB 171
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4429
Mailing Address - Country:US
Mailing Address - Phone:787-272-5656
Mailing Address - Fax:787-720-3232
Practice Address - Street 1:202 AVE ESMERALDA
Practice Address - Street 2:PONCE DE ELON
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4448
Practice Address - Country:US
Practice Address - Phone:787-272-5656
Practice Address - Fax:787-720-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7857261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081971Medicare ID - Type Unspecified