Basic Information
| Provider Information | |||||||||
| NPI: | 1891937314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARA DEL RIO | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | AGUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29134 | ||||||||
| Address2: | RADIOLOGIA RCM | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877773858 | ||||||||
| Practice Location | |||||||||
| Address1: | ASEM RADIOLOGIA RCM | ||||||||
| Address2: | CENTRO MEDICO DE PR BO MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877773858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2009 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 19002 | PR | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | 19002 | PR | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.