Healthcare Provider Details

I. General information

NPI: 1942234992
Provider Name (Legal Business Name): R.T. PORTABLE X-RAY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 WELLS CT
CEDAR HILL TX
75104-6943
US

IV. Provider business mailing address

2627 WELLS CT
CEDAR HILL TX
75104-6943
US

V. Phone/Fax

Practice location:
  • Phone: 972-523-6815
  • Fax: 214-515-9302
Mailing address:
  • Phone: 972-523-6815
  • Fax: 214-515-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number5810
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFAEL H RODRIGUEZ
Title or Position: PROVIDER
Credential: RT
Phone: 972-523-6815