Healthcare Provider Details

I. General information

NPI: 1205045085
Provider Name (Legal Business Name): LAGUNA GARDEN XRAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAGUNA GARDEN SHOPPING CENTER SUITE 204
CAROLINA PR
00979
US

IV. Provider business mailing address

10 AVE LAGUNA SUITE 204
CAROLINA PR
00979-6400
US

V. Phone/Fax

Practice location:
  • Phone: 787-791-5768
  • Fax: 787-791-5768
Mailing address:
  • Phone: 787-791-5768
  • Fax: 787-791-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number6199
License Number StatePR

VIII. Authorized Official

Name: DR. GILBERTO RAMOS
Title or Position: CO OWNER
Credential: MD
Phone: 787-791-5768