Provider Demographics
NPI:1578801247
Name:VASCULAR INTERVENTIONAL DIAGNOSTIC ASSOCIATES PSC
Entity Type:Organization
Organization Name:VASCULAR INTERVENTIONAL DIAGNOSTIC ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEVELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-599-2166
Mailing Address - Street 1:PO BOX 364164
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4164
Mailing Address - Country:US
Mailing Address - Phone:787-705-8675
Mailing Address - Fax:787-705-8676
Practice Address - Street 1:GUAYNABO MEDICAL MALL
Practice Address - Street 2:SUITE 208 B # 140 AVENIDA LAS CUMBRES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-705-8675
Practice Address - Fax:787-705-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology