Healthcare Provider Details

I. General information

NPI: 1316189533
Provider Name (Legal Business Name): GRUPO IMAGENES RADIOLOGICAS DEL NOROESTE CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE LUIS ESTEFANI
MAYAGUEZ PR
00682-5926
US

IV. Provider business mailing address

1 CALLE LUIS ESTEFANI
MAYAGUEZ PR
00682-5926
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-0612
  • Fax: 787-658-0612
Mailing address:
  • Phone: 787-658-0612
  • Fax: 787-658-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5377
License Number StatePR

VIII. Authorized Official

Name: DR. MOISES ORLANDO ACEVEDO
Title or Position: DIRECTOR
Credential: M.D
Phone: 787-658-0612