Provider Demographics
NPI:1528022100
Name:RIO GRANDE DIAGNOSTIC CSP
Entity Type:Organization
Organization Name:RIO GRANDE DIAGNOSTIC CSP
Other - Org Name:RIO GRANDE DIAGNOSTIC CSP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-247-1693
Mailing Address - Street 1:BOX 82 BO. PALMER
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE DIAGNOSTIC
Mailing Address - State:PR
Mailing Address - Zip Code:00721
Mailing Address - Country:US
Mailing Address - Phone:787-887-0555
Mailing Address - Fax:787-887-0111
Practice Address - Street 1:CALLE PRINCIPAL # 57 BO PALMER
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-0555
Practice Address - Fax:787-887-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty