Provider Demographics
NPI:1871646372
Name:FAJARDO IMAGING INC
Entity Type:Organization
Organization Name:FAJARDO IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RADIOLOGIST
Authorized Official - Phone:787-860-3400
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:PUERTO REAL
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0490
Mailing Address - Country:US
Mailing Address - Phone:787-860-3400
Mailing Address - Fax:787-863-2075
Practice Address - Street 1:316 GENERAL VALERO STREET
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-3400
Practice Address - Fax:787-863-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)