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General NPI Number Information
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NPI Number | 1881621019
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Entity Type | Organization
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Legal Business Name | SANTA MARIA RADIOLOGY, PSC
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 12/08/2008
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Provider Practice Location Address
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Address Line | 310 AVE. LOMAS VERDES SUITE 208
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City | SAN JUAN
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State | PR
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Zip | 00927-6638
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Country | US
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Telephone | 787-751-3150
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Fax | 787-767-0338
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Provider Business Mailing Address
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Address Line | 310 AVE. LOMAS VERDES SUITE 208
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City | SAN JUAN
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State | PR
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Zip | 00927-6638
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Country | US
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Telephone | 787-751-3150
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Fax | 787-767-0338
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BERNARDO JOSE MARQUES-DIAZ
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Credential | M.D.
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Telephone | 787-751-3150
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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 | 11700
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License Number State | PR
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