Provider Demographics
NPI:1538504352
Name:AGUADILLA RADIOLOGY, LLC
Entity Type:Organization
Organization Name:AGUADILLA RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIVERA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-891-6565
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0418
Mailing Address - Country:US
Mailing Address - Phone:787-891-6565
Mailing Address - Fax:787-891-6566
Practice Address - Street 1:2 CALLE PROGRESO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5000
Practice Address - Country:US
Practice Address - Phone:787-891-6565
Practice Address - Fax:787-891-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8589291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085431Medicare UPIN