MEDICARE: RAYOS X PEPINO HEALTH GROUP

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	261QR0206X	Mammography Clinic/Center	233600	PR

General Provider Information

NPI Number	:	1831315746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYOS X PEPINO HEALTH GROUP

Provider Business Mailing Address
First Line	:	P O BOX 1537
Second Line	:
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-1537
Country	:	US
Telephone Number	:	787-280-1335
Fax Number	:	787-896-0709

Provider Business Practice Location Address
First Line	:	CALLE PAVIA FERNANDEZ 126
Second Line	:
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-1537
Country	:	US
Telephone Number	:	787-280-1335
Fax Number	:	787-896-0709

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	DR. JUAN S ROBLES
Credential	:	MEDICO
Telephone Number	:	787-280-1335

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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