Provider Demographics
NPI:1104246552
Name:WEST TELERADIOLOGY PSC
Entity type:Organization
Organization Name:WEST TELERADIOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGUILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-806-8185
Mailing Address - Street 1:114 MENDEZ VIGO E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5052
Mailing Address - Country:US
Mailing Address - Phone:787-806-8185
Mailing Address - Fax:
Practice Address - Street 1:114 MENDEZ VIGO E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5052
Practice Address - Country:US
Practice Address - Phone:787-806-8185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13824261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21014OtherNPI # 1033227590
PR88632Medicare UPIN