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General NPI Number Information
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NPI Number | 1336606581
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Entity Type | Organization
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Legal Business Name | RADIOLOGIA SAN JORGE
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 258 CALLE SAN JORGE
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City | SAN JUAN
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State | PR
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Zip | 00912
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Country | US
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Telephone | 787-727-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6308 LOIZA STATION
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City | SAN JUAN
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State | PR
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Zip | 00912-6307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRADOR
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Name | DOMINGO CRUZ VIVALDI
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Credential |
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Telephone | 787-727-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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