1740579580 NPI number — HEALTH IMAGE DIAGNOSTICS, PSC

Table of content: (NPI 1740579580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740579580 NPI number — HEALTH IMAGE DIAGNOSTICS, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH IMAGE DIAGNOSTICS, 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:
SENOS
Provider Other Organization Name Type Code:
3
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:
1740579580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 AVE FD ROOSEVELT
Provider Second Line Business Mailing Address:
TORRE DE PLAZA LAS AMERICAS SUITE 403
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918-8001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-523-0952
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 AVE FD ROOSEVELT
Provider Second Line Business Practice Location Address:
TORRE DE PLAZA LAS AMERICAS SUITE 403
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-523-0952
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ESTELA JOVE
Authorized Official First Name:
DINORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRADORA
Authorized Official Telephone Number:
787-474-0820

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , 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)