MEDICARE: INSTITUTO SONORADIOLOGICO HOSTOS, INC

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		PR

General Provider Information

NPI Number	:	1992020648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTO SONORADIOLOGICO HOSTOS, INC

Provider Business Mailing Address
First Line	:	AVE. HOSTOS URB BALDRICH
Second Line	:	514 B
City	:	SAN JUAN
State	:	PR
Zip	:	00918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVE. HOSTOS URB BALDRICH
Second Line	:	514 B
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3248
Country	:	US
Telephone Number	:	787-766-1575
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YVELISSE GONZALEZ
Credential	:
Telephone Number	:	787-766-1575

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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