Provider Demographics
NPI:1609203827
Name:STA JUANITA 2 X-RAY SERVICES, INC.
Entity Type:Organization
Organization Name:STA JUANITA 2 X-RAY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OFELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-667-3475
Mailing Address - Street 1:PO BOX 56033
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6233
Mailing Address - Country:US
Mailing Address - Phone:787-251-4411
Mailing Address - Fax:787-798-7245
Practice Address - Street 1:AL26 CALLE 30
Practice Address - Street 2:URB SNTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4706
Practice Address - Country:US
Practice Address - Phone:787-251-4411
Practice Address - Fax:787-798-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR58182085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty