Provider Demographics
NPI:1356304505
Name:DIAGNOSTIC IMAGING CENTER, PSC
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING CENTER, PSC
Other - Org Name:NOVORAD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ GOYTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-294-0527
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0370
Mailing Address - Country:US
Mailing Address - Phone:787-294-0527
Mailing Address - Fax:
Practice Address - Street 1:369 AVE DE DIEGO
Practice Address - Street 2:TORRE DE SAN FRANCISCO SUITE 505
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-294-0527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84827Medicare ID - Type UnspecifiedPROVIDER NUMBER