Provider Demographics
NPI:1114042926
Name:SERVICIOS MEDICOS DEL VALLE DE LAJAS, INC
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS DEL VALLE DE LAJAS, INC
Other - Org Name:RADIOLOGIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:I
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-899-4242
Mailing Address - Street 1:PO BOX 1715
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1715
Mailing Address - Country:US
Mailing Address - Phone:787-899-4242
Mailing Address - Fax:787-899-8023
Practice Address - Street 1:237 AVE LOS VETERANOS
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2509
Practice Address - Country:US
Practice Address - Phone:787-899-4242
Practice Address - Fax:787-899-8023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERVICIOS MEDICOS DEL VALLE DE LAJAS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QE0002X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HU327AMedicare UPIN