Provider Demographics
NPI:1942939947
Name:SIMAGING DIAGNOSTIC & INTERVENTIONS-SIMA
Entity Type:Organization
Organization Name:SIMAGING DIAGNOSTIC & INTERVENTIONS-SIMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-925-9255
Mailing Address - Street 1:PO BOX 364426
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4426
Mailing Address - Country:US
Mailing Address - Phone:787-925-9255
Mailing Address - Fax:
Practice Address - Street 1:PONCE DE LEON AVENUE
Practice Address - Street 2:STOP 37 AND 1/2
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-925-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty