Provider Demographics
NPI:1770750317
Name:INTERNATIONAL RADIOLOGY CENTER & MEDICAL GROUP, PSC
Entity type:Organization
Organization Name:INTERNATIONAL RADIOLOGY CENTER & MEDICAL GROUP, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-999-5400
Mailing Address - Street 1:INTERNATIONAL MARKETING CENTER SUITE C-107
Mailing Address - Street 2:100 RD 165
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-8048
Mailing Address - Country:US
Mailing Address - Phone:787-999-5400
Mailing Address - Fax:787-999-5401
Practice Address - Street 1:INTERNATIONAL MARKETING CENTER SUITE C-107
Practice Address - Street 2:100 RD 165
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-8048
Practice Address - Country:US
Practice Address - Phone:787-999-5400
Practice Address - Fax:787-999-5401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNATIONAL RADIOLOGY CENTER & MEDICAL GROUP, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty