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General NPI Number Information
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NPI Number | 1902804545
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Entity Type | Organization
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Legal Business Name | SAN SEBASTIAN X RAY
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | CARR 111 KM 18.0 BIO MAHOMAMEY
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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 | 787-280-0981
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Fax | 787-280-0984
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Provider Business Mailing Address
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Address Line | PO BOX 3144
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-7003
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Country | US
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Telephone | 787-280-0981
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Fax | 787-280-0984
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Authorized Official
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Title or Position | OWNER
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Name | RAISA MUSA QUINONES
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Credential |
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Telephone | 787-280-0981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | 232321
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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