Provider Demographics
NPI:1750601183
Name:PONCE MEDICAL IMAGING
Entity type:Organization
Organization Name:PONCE MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-3395
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0720
Mailing Address - Country:US
Mailing Address - Phone:787-840-3395
Mailing Address - Fax:787-844-2664
Practice Address - Street 1:1326 CALLE SALUD
Practice Address - Street 2:EL SENORIAL PLAZA 105
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1686
Practice Address - Country:US
Practice Address - Phone:787-840-3395
Practice Address - Fax:787-844-2664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSTITUTO ULTRASONIDO Y MAMOGRAFIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6047261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79685Medicare UPIN
PR0027653Medicare PIN