Provider Demographics
NPI:1881621019
Name:SANTA MARIA RADIOLOGY, PSC
Entity type:Organization
Organization Name:SANTA MARIA RADIOLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MARQUES-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-751-3150
Mailing Address - Street 1:310 AVE. LOMAS VERDES SUITE 208
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6638
Mailing Address - Country:US
Mailing Address - Phone:787-751-3150
Mailing Address - Fax:787-767-0338
Practice Address - Street 1:310 AVE. LOMAS VERDES SUITE 208
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6638
Practice Address - Country:US
Practice Address - Phone:787-751-3150
Practice Address - Fax:787-767-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR117002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084891Medicare ID - Type Unspecified