Healthcare Provider Details

I. General information

NPI: 1629994850
Provider Name (Legal Business Name): CONCORDIA RADIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8159 CALLE CONCORDIA
PONCE PR
00717-1551
US

IV. Provider business mailing address

PO BOX 364426
SAN JUAN PR
00936-4426
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-2313
  • Fax:
Mailing address:
  • Phone: 787-925-9255
  • Fax: 787-842-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

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