Provider Demographics
NPI:1811468077
Name:NYQUIST IMAGING,LLC
Entity type:Organization
Organization Name:NYQUIST IMAGING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:G
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:915-494-4734
Mailing Address - Street 1:7248 COPPER TRAIL AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3415
Mailing Address - Country:US
Mailing Address - Phone:915-494-4734
Mailing Address - Fax:
Practice Address - Street 1:7248 COPPER TRAIL AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3415
Practice Address - Country:US
Practice Address - Phone:915-235-5279
Practice Address - Fax:915-219-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX823017Medicaid