Healthcare Provider Details

I. General information

NPI: 1609060581
Provider Name (Legal Business Name): DIAMAGE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE BALDORIOTY DE CASTRO 1B
VEGA BAJA PR
00693
US

IV. Provider business mailing address

D5 CALLE A EL ROSARIO
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-447-7196
  • Fax:
Mailing address:
  • Phone: 787-447-7196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JANICE MENDEZ
Title or Position: VASCULAR SONOGRAPHER
Credential: REGISTRY #6869
Phone: 787-447-7196