Provider Demographics
NPI:1861532954
Name:ADVANCED RADIOLOGY GROUP
Entity type:Organization
Organization Name:ADVANCED RADIOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-763-6336
Mailing Address - Street 1:#6 FERNANDEZ ST.
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-763-6336
Mailing Address - Fax:787-763-6207
Practice Address - Street 1:#6 FERNANDEZ ST.
Practice Address - Street 2:FLOOR 3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-763-6336
Practice Address - Fax:787-763-6207
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED RADIOLOGY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN
PR0026118Medicare ID - Type Unspecified