MEDICARE: CICOY IMAGING, 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	:	1881023125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CICOY IMAGING, PSC

Provider Business Mailing Address
First Line	:	1000 CALLE 42 SE
Second Line	:	REPARTO METROPOLITANO
City	:	SAN JUAN
State	:	PR
Zip	:	00921-2761
Country	:	US
Telephone Number	:	787-751-6400
Fax Number	:	787-523-1735

Provider Business Practice Location Address
First Line	:	1000 CALLE 42 SE
Second Line	:	REPARTO METROPOLITANO
City	:	SAN JUAN
State	:	PR
Zip	:	00921-2761
Country	:	US
Telephone Number	:	787-751-6400
Fax Number	:	787-523-1735

Authorized Official
Title or Position	:	CPA/CONTROLLER
Name	:	MR. FERMIN P GUERRA
Credential	:
Telephone Number	:	787-751-6400

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	11/07/2013

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