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General NPI Number Information
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NPI Number | 1902081425
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC IMAGIN SERVICES
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | CARR #111 KM 15.7 SANTA MARIA SHOPING CENTER L3
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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 | 787-896-8817
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Fax | 787-896-8817
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Provider Business Mailing Address
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Address Line | PARQUE SAN DE IGNACIO CALLE#1 A 44
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City | SAN JUAN
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State | PR
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Zip | 00921
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Country | US
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Telephone | 787-448-8888
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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. MANUEL F GONZALEZ
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Credential |
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Telephone | 787-448-8888
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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 | 11753
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License Number State | PR
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