Provider Demographics
NPI:1457775959
Name:VASCULAR INTERVENTIONAL RADIOLOGY & ONCOLOGY, PSC
Entity Type:Organization
Organization Name:VASCULAR INTERVENTIONAL RADIOLOGY & ONCOLOGY, PSC
Other - Org Name:VIRO PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BUONOMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-586-3371
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0748
Mailing Address - Country:US
Mailing Address - Phone:787-469-3796
Mailing Address - Fax:
Practice Address - Street 1:ROAD 14 KM 72.2 BO RINCON SECTOR LAS LOMAS
Practice Address - Street 2:HOSPITAL MENONITA CAYEY
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737
Practice Address - Country:US
Practice Address - Phone:787-469-3796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR184402085N0904X, 2085R0204X
PR0184402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty