Provider Demographics
NPI:1295117018
Name:EDEN E E
Entity type:Organization
Organization Name:EDEN E E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-869-9500
Mailing Address - Street 1:PO BOX 1345
Mailing Address - Street 2:PMB 293
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954
Mailing Address - Country:US
Mailing Address - Phone:787-869-9500
Mailing Address - Fax:787-869-5656
Practice Address - Street 1:CARR 164 KM 7.7
Practice Address - Street 2:CENTRO COM JARDINES DE NARANJITO
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-9500
Practice Address - Fax:787-869-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology