Healthcare Provider Details

I. General information

NPI: 1497023592
Provider Name (Legal Business Name): LAGUNA GARDENS RADIOLOGY AND IMAGING GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAGUNA GARDENS SHOPPING CENTER SUITE 106
CAROLINA PR
00979-6425
US

IV. Provider business mailing address

LAGUNA GARDENS SHOPPING CENTER SUITE 106
CAROLINA PR
00979-6525
US

V. Phone/Fax

Practice location:
  • Phone: 787-253-7070
  • Fax:
Mailing address:
  • Phone: 787-253-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUZ M. VILLANUEVA DIAZ
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 787-253-7070