MEDICARE: DIAGNOSTIC IMAGING CENTER, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1356304505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC IMAGING CENTER, PSC

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-0370
Country	:	US
Telephone Number	:	787-294-0527
Fax Number	:

Provider Business Practice Location Address
First Line	:	369 AVE DE DIEGO
Second Line	:	TORRE DE SAN FRANCISCO SUITE 505
City	:	SAN JUAN
State	:	PR
Zip	:	00923-3003
Country	:	US
Telephone Number	:	787-294-0527
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANCISCO GOMEZ GOYTIA
Credential	:	MD
Telephone Number	:	787-294-0527

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/22/2020

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