Provider Demographics
NPI:1063697415
Name:AIBONITO X RAY CORP
Entity type:Organization
Organization Name:AIBONITO X RAY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IBARRA
Authorized Official - Middle Name:ORTEGA
Authorized Official - Last Name:EDUARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-735-8900
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:AIBONITO
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1869
Mailing Address - Country:US
Mailing Address - Phone:787-735-8900
Mailing Address - Fax:787-735-3055
Practice Address - Street 1:204 CALLE JULIO CINTRON
Practice Address - Street 2:EDIFICIO GUAYACAN SUITE 112
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3311
Practice Address - Country:US
Practice Address - Phone:787-735-8900
Practice Address - Fax:787-735-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE08567Medicare UPIN