Provider Demographics
NPI:1689747149
Name:RADIOLOGOS ASOCIADOS DEL SUR
Entity Type:Organization
Organization Name:RADIOLOGOS ASOCIADOS DEL SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-842-3073
Mailing Address - Street 1:P.O. BOX 3300383
Mailing Address - Street 2:ATOCHA STATION
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-0383
Mailing Address - Country:US
Mailing Address - Phone:787-842-3073
Mailing Address - Fax:787-844-8510
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:EDIFICIO SAN VICENTE SUITE 1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1554
Practice Address - Country:US
Practice Address - Phone:787-842-3073
Practice Address - Fax:787-844-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9822174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085020BMedicare ID - Type Unspecified