Healthcare Provider Details

I. General information

NPI: 1376659631
Provider Name (Legal Business Name): MEDIKO IMAGING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VALENCIA II CALLE CASUL #52
JUNCOS PR
00777
US

IV. Provider business mailing address

PO BOX 8729
CAGUAS PR
00726-8729
US

V. Phone/Fax

Practice location:
  • Phone: 787-734-2552
  • Fax: 787-734-0688
Mailing address:
  • Phone: 787-743-1563
  • Fax: 787-745-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ABNER GONZALEZ COSTAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-743-1563