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General NPI Number Information
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NPI Number | 1699309161
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Entity Type | Organization
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Legal Business Name | ONCOLOGY & BODY IMAGING PSC
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 735 AVE PONCE DE LEON
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City | SAN JUAN
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State | PR
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Zip | 00917-5022
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Country | US
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Telephone | 787-758-2000
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Fax | 787-771-7927
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Provider Business Mailing Address
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Address Line | PO BOX 435
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City | ADJUNTAS
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State | PR
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Zip | 00601-0435
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Country | US
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Telephone | 787-630-4735
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORY BALLESTER ORTIZ
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Credential | MD
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Telephone | 787-630-4735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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