Provider Demographics
NPI:1982929212
Name:INSTITUTO RADIOLOGICO DE ARECIBO
Entity Type:Organization
Organization Name:INSTITUTO RADIOLOGICO DE ARECIBO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-878-6213
Mailing Address - Street 1:21 DE DIEGO AVE.
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4546
Mailing Address - Country:US
Mailing Address - Phone:787-878-6213
Mailing Address - Fax:787-878-4244
Practice Address - Street 1:21 DE DIEGO AVE.
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4546
Practice Address - Country:US
Practice Address - Phone:787-878-6213
Practice Address - Fax:787-878-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR01-198261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography