Healthcare Provider Details

I. General information

NPI: 1942939947
Provider Name (Legal Business Name): SIMAGING DIAGNOSTIC & INTERVENTIONS-SIMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PONCE DE LEON AVENUE STOP 37 AND 1/2
HATO REY PR
00919
US

IV. Provider business mailing address

PO BOX 364426
SAN JUAN PR
00936-4426
US

V. Phone/Fax

Practice location:
  • Phone: 787-925-9255
  • Fax:
Mailing address:
  • Phone: 787-925-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GORY BALLESTER
Title or Position: PRESIDENT
Credential: MD
Phone: 787-925-9255