MEDICARE: QUALITY IMAGING MEDICAL DIAGNOSTIC, INC.

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	207RC0000X	Cardiovascular Disease Physician	80189	PR
2	2085R0202X	Diagnostic Radiology Physician	80189	PR

General Provider Information

NPI Number	:	1811964422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY IMAGING MEDICAL DIAGNOSTIC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 56378
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-6878
Country	:	US
Telephone Number	:	787-780-0991
Fax Number	:	787-785-0844

Provider Business Practice Location Address
First Line	:	JR1 CALLE LIZZIE GRAHAM
Second Line	:	7MA SECC LEVITTOWN
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3637
Country	:	US
Telephone Number	:	787-780-0991
Fax Number	:	787-785-0844

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARLOS M PENTZKE
Credential	:	M.D.
Telephone Number	:	787-780-0991

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	09/11/2025

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