MEDICARE: ASHFORD MEDICAL CENTER RADIOLOGY OFFICES 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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84399	OTHER	PR	TRIPLE S
2	050860	OTHER	PR	CRUZ AZUL

General Provider Information

NPI Number	:	1568452951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHFORD MEDICAL CENTER RADIOLOGY OFFICES PSC

Provider Business Mailing Address
First Line	:	29 CALLE WASHINGTON
Second Line	:	STE 501
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1510
Country	:	US
Telephone Number	:	787-725-5955
Fax Number	:	787-722-7847

Provider Business Practice Location Address
First Line	:	1451 AVE ASHFORD
Second Line	:	RADIOLOGY DEPARTMENT 1ST FLOOR OF ASHFORD PRESBYTERIAN
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1511
Country	:	US
Telephone Number	:	787-725-5955
Fax Number	:	787-722-7847

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. TERESITA LANDRON
Credential	:	BA
Telephone Number	:	787-725-5955

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/22/2020

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