Provider Demographics
NPI:1629192471
Name:MEDICAL ANCILLARY DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:MEDICAL ANCILLARY DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERIBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-261-5173
Mailing Address - Street 1:4633 AVE ISLA VERDE
Mailing Address - Street 2:COND CASTILLO DEL MAR PMB 1409
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-5300
Mailing Address - Country:US
Mailing Address - Phone:787-261-5173
Mailing Address - Fax:787-261-2953
Practice Address - Street 1:AVE BOULEVARD EE20
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-5900
Practice Address - Country:US
Practice Address - Phone:787-261-5173
Practice Address - Fax:787-261-2953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0087889246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087889Medicare PIN