Healthcare Provider Details

I. General information

NPI: 1235253071
Provider Name (Legal Business Name): TRANSRAY DIAGNOSTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SAN MATEO BLVD NE STE 108
ALBUQUERQUE NM
87110-3166
US

IV. Provider business mailing address

9700 CONEFLOWER DR NW
ALBUQUERQUE NM
87114-3440
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-0475
  • Fax:
Mailing address:
  • Phone: 505-899-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

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