Provider Demographics
NPI:1942499108
Name:IMAGING DEVELOPMENT CORP
Entity Type:Organization
Organization Name:IMAGING DEVELOPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:
Authorized Official - First Name:FERMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-645-7523
Mailing Address - Street 1:100 GRAND BOULEVARD PASEOS
Mailing Address - Street 2:PMB 439 SUITE 112
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5902
Mailing Address - Country:US
Mailing Address - Phone:787-751-6400
Mailing Address - Fax:787-523-1735
Practice Address - Street 1:C/42 S.E #1000
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-751-6400
Practice Address - Fax:787-523-1735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMAGING DEVELOPMENT CORP AT LOIZA VALLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-23
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1711642085N0700X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty