MEDICARE: PROFESIONAL IMAGING CT CENTER

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1558395145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESIONAL IMAGING CT CENTER

Provider Business Mailing Address
First Line	:	PO BOX 8410
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-0410
Country	:	US
Telephone Number	:	787-727-5858
Fax Number	:	787-727-5960

Provider Business Practice Location Address
First Line	:	1822 AVE PONCE DE LEON
Second Line	:	PDA. 26 SANTURCE
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1906
Country	:	US
Telephone Number	:	787-727-5858
Fax Number	:	787-727-5960

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTOR R MERCADO
Credential	:	M.D.
Telephone Number	:	787-268-0101

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/22/2020

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