=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932263688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL IMAGING DIAGNOSTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. 172 3B11 3RA. SECC. VILLA DEL REY CARR. 172 3B11 3RA. SECC. VILLA DEL REY
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-744-0400
-----------------------------------------------------
Fax | 787-286-0606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB 660 P.O. BOX 4960 CARR. 172 3B11 3RA. SECC. VILLA DEL REY
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00726-4960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-744-0400
-----------------------------------------------------
Fax | 787-286-0606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRADORA
-----------------------------------------------------
Name | ANGELA TORREGROSA VICENTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-744-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------