Provider Demographics
NPI:1073641551
Name:HEALTH IMAGE DIAGNOSTIC PSC
Entity Type:Organization
Organization Name:HEALTH IMAGE DIAGNOSTIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZORAIDA
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:ESTELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-474-0820
Mailing Address - Street 1:525 FD ROOSEVELT
Mailing Address - Street 2:LA TORRE DE PLAZA LAS AMERICAS OFICINA 403
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-474-0820
Mailing Address - Fax:787-523-0955
Practice Address - Street 1:525 FD ROOSEVELT
Practice Address - Street 2:LA TORRE DE PLAZA LAS AMERICAS OFICINA 403
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-474-0820
Practice Address - Fax:787-523-0955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH IMAGE DIAGNOSTIC PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14142261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology