Provider Demographics
NPI:1093871055
Name:AGUADILLA X RAY OFFICE AND BODY IMAGING CENTER
Entity Type:Organization
Organization Name:AGUADILLA X RAY OFFICE AND BODY IMAGING CENTER
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:787-891-6565
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:787-891-6565
Mailing Address - Fax:787-891-6566
Practice Address - Street 1:CALLE PROGRESO #2 & #3
Practice Address - Street 2:AGUADILLA MEDICAL BLDG OFIC 302
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-0418
Practice Address - Country:US
Practice Address - Phone:787-891-6565
Practice Address - Fax:787-891-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0085892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G91287Medicare UPIN
PR0090001Medicare ID - Type Unspecified