Provider Demographics
NPI:1366767337
Name:AGUADILLA X-RAY OFFICE & BODY IMAGING CENTER, PSC
Entity type:Organization
Organization Name:AGUADILLA X-RAY OFFICE & BODY IMAGING CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIVERA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-891-6165
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0418
Mailing Address - Country:US
Mailing Address - Phone:787-891-6165
Mailing Address - Fax:787-891-6566
Practice Address - Street 1:AGUADILLA MED. BLDG., OFIC. 302
Practice Address - Street 2:PROGRESO #2 & #3
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-0418
Practice Address - Country:US
Practice Address - Phone:787-891-6165
Practice Address - Fax:787-891-6566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGUADILLA X-RAY OFFICE & BODY IMAGING CENTER, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0085892085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG91287Medicare UPIN