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General NPI Number Information
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NPI Number | 1487735684
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Entity Type | Organization
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Legal Business Name | ADVANCE DIGITAL IMAGE, CORP
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARRETARA # 111 INTERSECCION CARR 125 SEARS SHOPING CENTER
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685
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Country | US
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Telephone | 787-315-9401
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 626
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-0626
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Country | US
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Telephone | 787-315-9401
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOSE I RODRIGUEZ
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Credential |
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Telephone | 787-315-9401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 06171
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License Number State | PR
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