Provider Demographics
NPI:1053052852
Name:DE DIEGO AMBULATORY CLINIC CORP
Entity Type:Organization
Organization Name:DE DIEGO AMBULATORY CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND COLLECTION MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-977-7575
Mailing Address - Street 1:150 AVE DE DIEGO STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2309
Mailing Address - Country:US
Mailing Address - Phone:787-977-7575
Mailing Address - Fax:787-977-7586
Practice Address - Street 1:150 AVE DE DIEGO STE 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2309
Practice Address - Country:US
Practice Address - Phone:787-977-7575
Practice Address - Fax:787-977-7586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty