Provider Demographics
NPI:1578199733
Name:PRESTIGE DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:PRESTIGE DIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-304-0022
Mailing Address - Street 1:11240 VISTA DEL SOL DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5236
Mailing Address - Country:US
Mailing Address - Phone:915-304-0022
Mailing Address - Fax:915-304-0172
Practice Address - Street 1:11240 VISTA DEL SOL DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5236
Practice Address - Country:US
Practice Address - Phone:915-304-0022
Practice Address - Fax:915-304-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)