Provider Demographics
NPI:1225182298
Name:CAMUY X RAY & ULTRASOUND CENTER, PSC
Entity Type:Organization
Organization Name:CAMUY X RAY & ULTRASOUND CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-820-2122
Mailing Address - Street 1:45 URB VISTA VERDE
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-3302
Mailing Address - Country:US
Mailing Address - Phone:787-820-2122
Mailing Address - Fax:787-820-2105
Practice Address - Street 1:152 AVE MUNOZ RIVERA OESTE
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2309
Practice Address - Country:US
Practice Address - Phone:787-820-2122
Practice Address - Fax:787-820-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0070782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84397OtherTRIPLE S
PR0085094Medicare ID - Type Unspecified