Provider Demographics
NPI:1265621551
Name:GUAYAMA DIAGNOSTICS CSP
Entity type:Organization
Organization Name:GUAYAMA DIAGNOSTICS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RADIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BADILLO RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-864-5670
Mailing Address - Street 1:PO BOX 10007
Mailing Address - Street 2:SUITE 417
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-4007
Mailing Address - Country:US
Mailing Address - Phone:787-864-5670
Mailing Address - Fax:787-864-5714
Practice Address - Street 1:CALLE ASHFORD #1
Practice Address - Street 2:ESQ VICENTE PALES
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4950
Practice Address - Country:US
Practice Address - Phone:787-864-5670
Practice Address - Fax:787-864-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology