Healthcare Provider Details

I. General information

NPI: 1649934969
Provider Name (Legal Business Name): INNOVATIVE IMAGING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 CALLE ARAGUEZ
VEGA BAJA PR
00693-3689
US

IV. Provider business mailing address

770 CALLE ARAGUEZ
VEGA BAJA PR
00693-3689
US

V. Phone/Fax

Practice location:
  • Phone: 787-688-4794
  • Fax:
Mailing address:
  • Phone: 787-688-4794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSUE EFRAIN RAMOS ROSA
Title or Position: VICE PRESIDENT
Credential:
Phone: 787-688-4794