Provider Demographics
NPI:1003871583
Name:SAN GERMAN X RAY & BODY IMAGING CENTER, PSC.
Entity Type:Organization
Organization Name:SAN GERMAN X RAY & BODY IMAGING CENTER, PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ FERRER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-892-5030
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0559
Mailing Address - Country:US
Mailing Address - Phone:787-892-5030
Mailing Address - Fax:787-264-7279
Practice Address - Street 1:43 CALLE DR VEVE
Practice Address - Street 2:EDIFICIO GROVAS RODRIGUEZ SUITE 1
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4100
Practice Address - Country:US
Practice Address - Phone:787-892-5030
Practice Address - Fax:787-264-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84804Medicare ID - Type Unspecified