Healthcare Provider Details

I. General information

NPI: 1184664633
Provider Name (Legal Business Name): IMAGING & RADIOLOGY ADVOCATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL BUEN SAMARITANO DEPT. RADIOLOGIA OFICINA DE RADIOLOGOS
AGUADILLA PR
00605-0363
US

IV. Provider business mailing address

PO BOX 123
ISABELA PR
00662-0123
US

V. Phone/Fax

Practice location:
  • Phone: 787-903-0033
  • Fax: 787-524-7400
Mailing address:
  • Phone: 787-903-0033
  • Fax: 787-524-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13,022
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number13,022
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number13,022
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number13,022
License Number StatePR

VIII. Authorized Official

Name: DR. SAUL CORDERO CALERO
Title or Position: PRESIDENT / NEURORADIOLOGO
Credential: M.D.
Phone: 787-469-8981