Basic Information
| Provider Information | |||||||||
| NPI: | 1922364447 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY DIAGNOSTIX PSC | ||||||||
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| OtherOrganizationName: | RADIOLOGY DIAGNOSTIX | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 AVE LA SIERRA | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009264330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875292964 | ||||||||
| FaxNumber: | 7877488895 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 AVE FD ROOSEVELT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009182103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875292964 | ||||||||
| FaxNumber: | 7877488895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2012 | ||||||||
| LastUpdateDate: | 04/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | MALDONADO | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7875292964 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 14572 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.