Provider Demographics
NPI:1780838722
Name:ESCORIAL IMAGING CENTER, PSC
Entity Type:Organization
Organization Name:ESCORIAL IMAGING CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HORACIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLON-ESTEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-721-5135
Mailing Address - Street 1:PO BOX 8990
Mailing Address - Street 2:FERNANDEZ JUNCOS STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0990
Mailing Address - Country:US
Mailing Address - Phone:787-721-5135
Mailing Address - Fax:787-725-1790
Practice Address - Street 1:1400 PARK SOUTH AVENUE, PARQUE ESCORIAL
Practice Address - Street 2:ESCORIAL BUILDING ONE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-721-5135
Practice Address - Fax:787-725-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR163561261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)