MEDICARE: NATIONAL ADVANCED DIAGNOSTIC IMAGING SUB-SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1538324462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL ADVANCED DIAGNOSTIC IMAGING SUB-SPECIALISTS

Provider Business Mailing Address
First Line	:	URB LAS CUMBRES 497 EMILIANO POL
Second Line	:	PMB 283
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5636
Country	:	US
Telephone Number	:	816-309-2266
Fax Number	:	787-283-1173

Provider Business Practice Location Address
First Line	:	URB LAS CUMBRES 497 EMILIANO POL
Second Line	:	PMB 283
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5636
Country	:	US
Telephone Number	:	816-309-2266
Fax Number	:	787-283-1173

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JORGE A VIDAL
Credential	:	M.D.
Telephone Number	:	816-309-2266

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/28/2008

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