1902804545 NPI number — SAN SEBASTIAN X RAY

Table of content: (NPI 1902804545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902804545 NPI number — SAN SEBASTIAN X RAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN SEBASTIAN X RAY
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:
1902804545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-7003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-280-0981
Provider Business Mailing Address Fax Number:
787-280-0984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 111 KM 18.0 BIO MAHOMAMEY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-280-0981
Provider Business Practice Location Address Fax Number:
787-280-0984
Provider Enumeration Date:
07/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MUSA QUINONES
Authorized Official First Name:
RAISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-280-0981

Provider Taxonomy Codes

  • Taxonomy code: 2471M2300X , with the licence number:  232321 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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