Provider Demographics
NPI:1982961918
Name:RELIABLE RADIOLOGY PSC
Entity Type:Organization
Organization Name:RELIABLE RADIOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRALOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FERMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-751-6400
Mailing Address - Street 1:100 GRAND BOULEVARD PASEOS
Mailing Address - Street 2:PMB 439 SUITE 112
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND BOULEVARD PASEOS
Practice Address - Street 2:PMB 439 SUITE 112
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5902
Practice Address - Country:US
Practice Address - Phone:787-751-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR300897291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory