Provider Demographics
NPI:1619950227
Name:INSTITUTO SONORADIOLOGICO HOSTOS
Entity Type:Organization
Organization Name:INSTITUTO SONORADIOLOGICO HOSTOS
Other - Org Name:INSTITUTO SONO-RADIOLOGICO HOSTOS, INC. C.S.P.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DUENA
Authorized Official - Prefix:DR
Authorized Official - First Name:YVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ SEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-766-1575
Mailing Address - Street 1:URB BALDRICH
Mailing Address - Street 2:AVE HOSTOS 514 B
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-766-1575
Mailing Address - Fax:787-766-1574
Practice Address - Street 1:URB BALDRICH
Practice Address - Street 2:AVE HOSTOS 514 B
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-766-1575
Practice Address - Fax:787-766-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FD992AMedicare PIN