Healthcare Provider Details

I. General information

NPI: 1811005812
Provider Name (Legal Business Name): SIMED DIAGNOSTIC GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. AGUAS BUENAS #1630 URB. SANTA ROSA
BAYAMON PR
00959-6652
US

IV. Provider business mailing address

PMB 152 AVE. ESMERALDA #53
GUAYNABO PR
00969-4429
US

V. Phone/Fax

Practice location:
  • Phone: 787-368-5010
  • Fax:
Mailing address:
  • Phone: 787-778-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ZUZEL BARBARA CANTILLO
Title or Position: PRESIDENTA
Credential:
Phone: 787-368-5010