Provider Demographics
NPI:1235608514
Name:MEDIKO IMAGING INC.
Entity Type:Organization
Organization Name:MEDIKO IMAGING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABNER
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ COSTAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-403-4787
Mailing Address - Street 1:PO BOX 8729
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8729
Mailing Address - Country:US
Mailing Address - Phone:787-743-1563
Mailing Address - Fax:
Practice Address - Street 1:CALLE VICTORIA #12
Practice Address - Street 2:BARRIO TEJAS
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-743-1563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty