Healthcare Provider Details

I. General information

NPI: 1275693780
Provider Name (Legal Business Name): TRANSRAY DIAGNOSTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 OSUNA RD NE SUITE 3
ALBUQUERQUE NM
87113-1391
US

IV. Provider business mailing address

PO BOX 70035
ALBUQUERQUE NM
87197-0035
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-6018
  • Fax: 505-883-0608
Mailing address:
  • Phone: 505-717-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberRRT00642
License Number StateNM

VIII. Authorized Official

Name: GINA T CONSTANT
Title or Position: VP
Credential:
Phone: 505-899-4018