Provider Demographics
NPI:1134193485
Name:IMAGENES RADIOLOGICAS DEL CARIBE
Entity type:Organization
Organization Name:IMAGENES RADIOLOGICAS DEL CARIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALDUONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-620-5757
Mailing Address - Street 1:1508 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-0001
Mailing Address - Country:US
Mailing Address - Phone:787-620-5757
Mailing Address - Fax:787-620-5758
Practice Address - Street 1:1508 ROOSEVELT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-0001
Practice Address - Country:US
Practice Address - Phone:787-620-5757
Practice Address - Fax:787-620-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12263261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084997Medicare PIN