Provider Demographics
NPI:1013170703
Name:J K RADIOLOGY GROUP INC
Entity Type:Organization
Organization Name:J K RADIOLOGY GROUP INC
Other - Org Name:TRUJILO ALTO IMAGING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTIAGO VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-748-2840
Mailing Address - Street 1:EDIF. N APT. 205
Mailing Address - Street 2:COND. WOODLAND
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-748-2840
Mailing Address - Fax:787-748-2840
Practice Address - Street 1:AVE 181 KM 2.1
Practice Address - Street 2:TRUJILLO MEDICAL SUITE 202 Y 203
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-748-2840
Practice Address - Fax:787-748-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTA0913OtherRADIOLOGY