Provider Demographics
NPI:1639458227
Name:AGUADILLA RADIOLOGY CENTER
Entity Type:Organization
Organization Name:AGUADILLA RADIOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-891-6038
Mailing Address - Street 1:31 PARQUE LA ARBOLEDA
Mailing Address - Street 2:CARR 467 KM 6.1 INTERIOR
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-6743
Mailing Address - Country:US
Mailing Address - Phone:787-891-6038
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 107 KM 3.3 BARRIO BORINQUEN
Practice Address - Street 2:AVE. PEDRO ALBIZU CAMPOS
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-6038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology