Healthcare Provider Details

I. General information

NPI: 1730337189
Provider Name (Legal Business Name): BARCELONETAS MEDICAL & IMAGING GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE TOMAS DAVILA
BARCELONETA PR
00617-2798
US

IV. Provider business mailing address

315 AVE DOMENECH
SAN JUAN PR
00918-3513
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-9791
  • Fax:
Mailing address:
  • Phone: 787-764-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number13207
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. EDGAR C HERNANDEZ VIERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-764-9560