Basic Information
| Provider Information | |||||||||
| NPI: | 1457674939 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MODERN RADIOLOGY ,PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7346 | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007327346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878431625 | ||||||||
| FaxNumber: | 7872591117 | ||||||||
| Practice Location | |||||||||
| Address1: | TORRE MEDICA SAN CRISTOBAL 5TA AVE OFICINA 109 | ||||||||
| Address2: | |||||||||
| City: | COTO LAUREL | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878431625 | ||||||||
| FaxNumber: | 7872591117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | BERMUDEZ-RUIZ | ||||||||
| AuthorizedOfficialFirstName: | GAMALIER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878431625 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 4816 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.