Healthcare Provider Details

I. General information

NPI: 1447474465
Provider Name (Legal Business Name): SP RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CALLE SANTA CRUZ
BAYAMON PR
00961-7052
US

IV. Provider business mailing address

PO BOX 4980
CAGUAS PR
00726-4980
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-4747
  • Fax:
Mailing address:
  • Phone: 787-620-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: PEDRO COLLAZO-ORNES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-620-4747