Healthcare Provider Details

I. General information

NPI: 1629582366
Provider Name (Legal Business Name): X-RADIO PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 181 KM 0 EDIFICIO CENTRO 4 SUITE 208
TRUJILLO ALTO PR
00976-0000
US

IV. Provider business mailing address

PO BOX 260905
SAN JUAN PR
00926-2629
US

V. Phone/Fax

Practice location:
  • Phone: 787-755-1075
  • Fax: 787-755-1075
Mailing address:
  • Phone: 787-755-1075
  • Fax: 787-755-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number13249
License Number StatePR

VIII. Authorized Official

Name: DR. VILMA M VARGAS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-755-1075