Provider Demographics
NPI:1518060847
Name:TMR DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:TMR DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-274-0484
Mailing Address - Street 1:PO BOX 70169
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8169
Mailing Address - Country:US
Mailing Address - Phone:787-274-0484
Mailing Address - Fax:
Practice Address - Street 1:BUSTAMANTE STREET # 550
Practice Address - Street 2:DOMENECH AVE.
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-274-0484
Practice Address - Fax:787-274-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5369261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82772Medicare ID - Type Unspecified