MEDICARE: SANTA MARIA RADIOLOGY, PSC

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	11700	PR

General Provider Information

NPI Number	:	1881621019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA MARIA RADIOLOGY, PSC

Provider Business Mailing Address
First Line	:	310 AVE. LOMAS VERDES SUITE 208
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6638
Country	:	US
Telephone Number	:	787-751-3150
Fax Number	:	787-767-0338

Provider Business Practice Location Address
First Line	:	310 AVE. LOMAS VERDES SUITE 208
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6638
Country	:	US
Telephone Number	:	787-751-3150
Fax Number	:	787-767-0338

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. BERNARDO JOSE MARQUES-DIAZ
Credential	:	M.D.
Telephone Number	:	787-751-3150

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	12/08/2008

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