Provider Demographics
NPI:1801031174
Name:INNOVA RADIOLOGY SERVICES,PSC
Entity Type:Organization
Organization Name:INNOVA RADIOLOGY SERVICES,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-404-2424
Mailing Address - Street 1:162 CALLE BEGONIA
Mailing Address - Street 2:CIUDAD JARDIN 2
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4855
Mailing Address - Country:US
Mailing Address - Phone:787-404-2424
Mailing Address - Fax:787-269-5212
Practice Address - Street 1:162 CALLE BEGONIA
Practice Address - Street 2:CIUDAD JARDIN 2
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-4855
Practice Address - Country:US
Practice Address - Phone:787-404-2424
Practice Address - Fax:787-269-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13263261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology