Healthcare Provider Details

I. General information

NPI: 1609203827
Provider Name (Legal Business Name): STA JUANITA 2 X-RAY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AL26 CALLE 30 URB SNTA JUANITA
BAYAMON PR
00956-4706
US

IV. Provider business mailing address

PO BOX 56033
BAYAMON PR
00960-6233
US

V. Phone/Fax

Practice location:
  • Phone: 787-251-4411
  • Fax: 787-798-7245
Mailing address:
  • Phone: 787-251-4411
  • Fax: 787-798-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5818
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number5818
License Number StatePR

VIII. Authorized Official

Name: DR. OFELIO ROSADO
Title or Position: RADIOLOGIST
Credential: MD
Phone: 787-667-3475