Healthcare Provider Details

I. General information

NPI: 1467625301
Provider Name (Legal Business Name): RADHEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD PR 2 MARGINAL D-10 URB. VILLA REAL
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 1498
VEGA BAJA PR
00694-1498
US

V. Phone/Fax

Practice location:
  • Phone: 787-807-0900
  • Fax:
Mailing address:
  • Phone: 787-807-0900
  • Fax: 787-855-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13446
License Number StatePR

VIII. Authorized Official

Name: DR. MANUEL MEDINA
Title or Position: PRESIDENT
Credential:
Phone: 787-807-0900