Provider Demographics
NPI:1912452525
Name:NEW VISION MEDICAL DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:NEW VISION MEDICAL DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACTURADORA
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-778-5353
Mailing Address - Street 1:PO BOX 6350
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00960
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE. BETANCES URB. HERMANAS DAVILAS
Practice Address - Street 2:J-23
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00959
Practice Address - Country:UM
Practice Address - Phone:787-778-5353
Practice Address - Fax:787-778-5302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW VISION MEDICAL DIAGNOSTICS ,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR121252261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherNCQA