Provider Demographics
NPI:1629250923
Name:HOME IMAGES, PSC.
Entity Type:Organization
Organization Name:HOME IMAGES, PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE-JESUS-BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-200-6970
Mailing Address - Street 1:AVENIDA BORINQUEN NUMERO110
Mailing Address - Street 2:SUITE 3-2
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-200-6970
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA BORINQUEN NUMERO110
Practice Address - Street 2:SUITE 3-2
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-200-6970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2762247100000X
PR09-183247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty