Healthcare Provider Details

I. General information

NPI: 1639335284
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING AT DOCTORS CENTER HOSPITAL P S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 47.7 BO. COTTO NORTE
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 30532
MANATI PR
00674-8513
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3322
  • Fax: 787-621-3311
Mailing address:
  • Phone: 787-621-3322
  • Fax: 787-621-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7466
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0080308
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerMEDICARE ID

VIII. Authorized Official

Name: LORRAINE VAZQUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-621-3322