Healthcare Provider Details

I. General information

NPI: 1205309325
Provider Name (Legal Business Name): SULTANA DIAGNOSTIC AND RADIOLOGIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

Q3-19 URB LAS LOMAS
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 1081
TOA ALTA PR
00954-1081
US

V. Phone/Fax

Practice location:
  • Phone: 787-461-0460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOENITH BONILLA GARCIA
Title or Position: PRESIDENTE
Credential:
Phone: 787-461-0460