MEDICARE: RADIOLOGIA & SONOGRAFIA DE GUAYNABO

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	261QR0206X	Mammography Clinic/Center	7857	PR

General Provider Information

NPI Number	:	1649305137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGIA & SONOGRAFIA DE GUAYNABO

Provider Business Mailing Address
First Line	:	53 AVE ESMERALDA
Second Line	:	PMB 171
City	:	GUAYNABO
State	:	PR
Zip	:	00969-4429
Country	:	US
Telephone Number	:	787-272-5656
Fax Number	:	787-720-3232

Provider Business Practice Location Address
First Line	:	202 AVE ESMERALDA
Second Line	:	PONCE DE ELON
City	:	GUAYNABO
State	:	PR
Zip	:	00969-4448
Country	:	US
Telephone Number	:	787-272-5656
Fax Number	:	787-720-3232

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IRMA NYDIA COLON
Credential	:	MD
Telephone Number	:	787-272-5656

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	03/09/2012

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Directions to “RADIOLOGIA & SONOGRAFIA DE GUAYNABO ” Practice Location

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