Healthcare Provider Details

I. General information

NPI: 1750340055
Provider Name (Legal Business Name): SOCIEDAD RADIOLOGICA DE BAYAMON SERVICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CALLE SANTA CRUZ EDIFICIO MEDICO STA CRUZ OFIC 103
BAYAMON PR
00961-6910
US

IV. Provider business mailing address

PO BOX 70152
SAN JUAN PR
00936-8152
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-4557
  • Fax: 787-740-1399
Mailing address:
  • Phone: 787-785-4620
  • Fax: 787-740-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
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: DR. SAMUEL GARAU
Title or Position: PRESIDENT
Credential: MD
Phone: 787-785-8110