Provider Demographics
NPI:1386863975
Name:NOGAL RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:NOGAL RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NITZA
Authorized Official - Middle Name:MAGALI
Authorized Official - Last Name:DEMARI-PRATS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-787-3581
Mailing Address - Street 1:PO BOX 366684
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6684
Mailing Address - Country:US
Mailing Address - Phone:787-787-3581
Mailing Address - Fax:787-740-0080
Practice Address - Street 1:4X68 CALLE QUINA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-2965
Practice Address - Country:US
Practice Address - Phone:787-787-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR42222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89654Medicare ID - Type Unspecified