Provider Demographics
NPI:1750040028
Name:FIESTA IMAGING, LP
Entity Type:Organization
Organization Name:FIESTA IMAGING, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-299-7600
Mailing Address - Street 1:8706 FREDERICKSBURG RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1293
Mailing Address - Country:US
Mailing Address - Phone:210-299-7600
Mailing Address - Fax:210-299-7610
Practice Address - Street 1:8706 FREDERICKSBURG RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1293
Practice Address - Country:US
Practice Address - Phone:210-299-7600
Practice Address - Fax:210-299-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty