1225277973 NPI number — ESCORIAL MRI & CT IMAGING CENTER, PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225277973 NPI number — ESCORIAL MRI & CT IMAGING CENTER, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESCORIAL MRI & CT IMAGING CENTER, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225277973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8990
Provider Second Line Business Mailing Address:
FERNANDEZ JUNCOS STATION
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00910-0990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-721-5135
Provider Business Mailing Address Fax Number:
787-725-1790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ESCORIAL BLDG. ONE, 1400 PARK SOUTH AVENUE
Provider Second Line Business Practice Location Address:
PARQUE ESCORIAL
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-721-5135
Provider Business Practice Location Address Fax Number:
787-725-1790
Provider Enumeration Date:
02/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COLON
Authorized Official First Name:
HORACIO
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-721-5135

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  163561 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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