Provider Demographics
NPI:1881023125
Name:CICOY IMAGING, PSC
Entity Type:Organization
Organization Name:CICOY IMAGING, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPA/CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:FERMIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-751-6400
Mailing Address - Street 1:1000 CALLE 42 SE
Mailing Address - Street 2:REPARTO METROPOLITANO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2761
Mailing Address - Country:US
Mailing Address - Phone:787-751-6400
Mailing Address - Fax:787-523-1735
Practice Address - Street 1:1000 CALLE 42 SE
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2761
Practice Address - Country:US
Practice Address - Phone:787-751-6400
Practice Address - Fax:787-523-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology