Provider Demographics
NPI:1568452951
Name:ASHFORD MEDICAL CENTER RADIOLOGY OFFICES PSC
Entity Type:Organization
Organization Name:ASHFORD MEDICAL CENTER RADIOLOGY OFFICES PSC
Other - Org Name:ASHFORD MED CTR RADIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:787-725-5955
Mailing Address - Street 1:29 CALLE WASHINGTON
Mailing Address - Street 2:STE 501
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1510
Mailing Address - Country:US
Mailing Address - Phone:787-725-5955
Mailing Address - Fax:787-722-7847
Practice Address - Street 1:1451 AVE ASHFORD
Practice Address - Street 2:RADIOLOGY DEPARTMENT 1ST FLOOR OF ASHFORD PRESBYTERIAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1511
Practice Address - Country:US
Practice Address - Phone:787-725-5955
Practice Address - Fax:787-722-7847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84399OtherTRIPLE S
PR050860OtherCRUZ AZUL