Provider Demographics
NPI:1508894163
Name:IMAGDENT
Entity Type:Organization
Organization Name:IMAGDENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMAGING COORDINATOR/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-404-1215
Mailing Address - Street 1:14329 SAN PEDRO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4389
Mailing Address - Country:US
Mailing Address - Phone:210-404-1215
Mailing Address - Fax:210-404-1218
Practice Address - Street 1:14329 SAN PEDRO AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4389
Practice Address - Country:US
Practice Address - Phone:210-404-1215
Practice Address - Fax:210-404-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty