Provider Demographics
NPI:1801294210
Name:PADMA IMAGING CENTER
Entity type:Organization
Organization Name:PADMA IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIA
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-486-9898
Mailing Address - Street 1:URBANIZACION EL RETIRO
Mailing Address - Street 2:85 AGRICULTURA
Mailing Address - City:CAGUAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00725
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:482 CALLE CESAR GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2627
Practice Address - Country:US
Practice Address - Phone:787-751-5685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1317452OtherLICENCIA CONDUCIR