Provider Demographics
NPI:1326042797
Name:X-RAY DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:X-RAY DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST-VICE-PRES
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-4770
Mailing Address - Street 1:PO BOX 3247
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3247
Mailing Address - Country:US
Mailing Address - Phone:787-834-4770
Mailing Address - Fax:787-265-2120
Practice Address - Street 1:16 CALLE DR BASORA N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4832
Practice Address - Country:US
Practice Address - Phone:787-834-4770
Practice Address - Fax:787-265-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR77772085R0202X
PR71392085R0202X
PR91802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080053Medicare PIN