Healthcare Provider Details

I. General information

NPI: 1871646372
Provider Name (Legal Business Name): FAJARDO IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 GENERAL VALERO STREET
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 490 PUERTO REAL
FAJARDO PR
00738-0490
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-3400
  • Fax: 787-863-2075
Mailing address:
  • Phone: 787-860-3400
  • Fax: 787-863-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DIANA FERNANDEZ
Title or Position: PRESIDENTOWNER
Credential: RADIOLOGIST
Phone: 787-860-3400