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General NPI Number Information
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NPI Number | 1649305137
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Entity Type | Organization
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Legal Business Name | RADIOLOGIA & SONOGRAFIA DE GUAYNABO
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 202 AVE ESMERALDA PONCE DE ELON
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City | GUAYNABO
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State | PR
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Zip | 00969-4448
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Country | US
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Telephone | 787-272-5656
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Fax | 787-720-3232
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Provider Business Mailing Address
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Address Line | 53 AVE ESMERALDA PMB 171
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City | GUAYNABO
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State | PR
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Zip | 00969-4429
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Country | US
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Telephone | 787-272-5656
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Fax | 787-720-3232
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRMA NYDIA COLON
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Credential | MD
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Telephone | 787-272-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 7857
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License Number State | PR
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