Provider Demographics
NPI:1144349143
Name:MJ IMAGING CENTER INC.
Entity type:Organization
Organization Name:MJ IMAGING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MISAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-608-4397
Mailing Address - Street 1:160 CALLE FLAMBOYAN
Mailing Address - Street 2:VALLE ARRIBA
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-3647
Mailing Address - Country:US
Mailing Address - Phone:787-608-4397
Mailing Address - Fax:
Practice Address - Street 1:CARETERA 153 KM7.8
Practice Address - Street 2:PLAZA SANTA ISABEL
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-3801
Practice Address - Country:US
Practice Address - Phone:787-608-4397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06162261QM1200X, 261QR0206X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography