Provider Demographics
NPI:1275390775
Name:WAVES RADIOLOGY AT SAN ANTONIO HOSPITAL
Entity Type:Organization
Organization Name:WAVES RADIOLOGY AT SAN ANTONIO HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-209-7705
Mailing Address - Street 1:PO BOX 3250
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3250
Mailing Address - Country:US
Mailing Address - Phone:787-464-3992
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE DR RAMON E BETANCES N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-6626
Practice Address - Country:US
Practice Address - Phone:787-464-3992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty