Provider Demographics
NPI:1366429003
Name:THE RADIOLOGY INSTITUTE
Entity type:Organization
Organization Name:THE RADIOLOGY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BONNET
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:787-765-7713
Mailing Address - Street 1:400 AVE FD ROOSEVELT
Mailing Address - Street 2:SUITE 101 CLINICA LAS AMERICAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2103
Mailing Address - Country:US
Mailing Address - Phone:787-765-7713
Mailing Address - Fax:787-250-7967
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 101 CLINICA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-765-7713
Practice Address - Fax:787-250-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207U00000X, 2085N0904X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-4104Medicare ID - Type Unspecified