Provider Demographics
NPI:1205045085
Name:LAGUNA GARDEN XRAY
Entity Type:Organization
Organization Name:LAGUNA GARDEN XRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-791-5768
Mailing Address - Street 1:10 AVE LAGUNA
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6400
Mailing Address - Country:US
Mailing Address - Phone:787-791-5768
Mailing Address - Fax:787-791-5768
Practice Address - Street 1:LAGUNA GARDEN SHOPPING CENTER
Practice Address - Street 2:SUITE 204
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-791-5768
Practice Address - Fax:787-791-5768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6199261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081080Medicare ID - Type Unspecified