Provider Demographics
NPI:1629582366
Name:X-RADIO PSC
Entity Type:Organization
Organization Name:X-RADIO PSC
Other - Org Name:RAYOS X CENTRO 4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-755-1075
Mailing Address - Street 1:PO BOX 260905
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2629
Mailing Address - Country:US
Mailing Address - Phone:787-755-1075
Mailing Address - Fax:787-755-0265
Practice Address - Street 1:CARR 181 KM 0
Practice Address - Street 2:EDIFICIO CENTRO 4 SUITE 208
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-0000
Practice Address - Country:US
Practice Address - Phone:787-755-1075
Practice Address - Fax:787-755-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085N0700X
PR13249261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty