1861532954 NPI number — ADVANCED RADIOLOGY GROUP

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 1861532954 NPI number — ADVANCED RADIOLOGY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED RADIOLOGY GROUP
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:
1861532954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#6 FERNANDEZ ST.
Provider Second Line Business Mailing Address:
FLOOR 3
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-763-6336
Provider Business Mailing Address Fax Number:
787-763-6207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#6 FERNANDEZ ST.
Provider Second Line Business Practice Location Address:
FLOOR 3
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-763-6336
Provider Business Practice Location Address Fax Number:
787-763-6207
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
WILMA
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNERSHIP
Authorized Official Telephone Number:
787-763-6336

Provider Taxonomy Codes

  • Taxonomy code: 261QR0206X , 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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