Healthcare Provider Details

I. General information

NPI: 1861532954
Provider Name (Legal Business Name): ADVANCED RADIOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#6 FERNANDEZ ST. FLOOR 3
SAN JUAN PR
00917
US

IV. Provider business mailing address

#6 FERNANDEZ ST. FLOOR 3
SAN JUAN PR
00917
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-6336
  • Fax: 787-763-6207
Mailing address:
  • Phone: 787-763-6336
  • Fax: 787-763-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILMA RODRIGUEZ
Title or Position: PARTNERSHIP
Credential: MD
Phone: 787-763-6336