Provider Demographics
NPI:1184664633
Name:IMAGING & RADIOLOGY ADVOCATES PSC
Entity Type:Organization
Organization Name:IMAGING & RADIOLOGY ADVOCATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / NEURORADIOLOGO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:CORDERO
Authorized Official - Last Name:CALERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-469-8981
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0123
Mailing Address - Country:US
Mailing Address - Phone:787-903-0033
Mailing Address - Fax:787-524-7400
Practice Address - Street 1:HOSPITAL BUEN SAMARITANO
Practice Address - Street 2:DEPT. RADIOLOGIA OFICINA DE RADIOLOGOS
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-0363
Practice Address - Country:US
Practice Address - Phone:787-903-0033
Practice Address - Fax:787-524-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13,0222085N0700X, 2085R0202X, 2085U0001X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFW332ZOtherMEDICARE PTAN
PR2,886OtherNUMERO DEPARTAMENTO DE ESTADO
PR0020381Medicare ID - Type Unspecified
PR2,886OtherNUMERO DEPARTAMENTO DE ESTADO