Provider Demographics
NPI:1508892159
Name:SIGNET PUERTO RICO
Entity Type:Organization
Organization Name:SIGNET PUERTO RICO
Other - Org Name:SAN JUAN MRI & CT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:NIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUFFRONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-721-7776
Mailing Address - Street 1:1448 AVE FERNANDEZ JUNCOS
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2655
Mailing Address - Country:US
Mailing Address - Phone:787-721-7776
Mailing Address - Fax:787-721-7774
Practice Address - Street 1:1448 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2655
Practice Address - Country:US
Practice Address - Phone:787-721-7776
Practice Address - Fax:787-721-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13263261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)