Provider Demographics
NPI:1427293844
Name:PUERTO RICO IMAGING SJ INC
Entity type:Organization
Organization Name:PUERTO RICO IMAGING SJ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-629-5280
Mailing Address - Street 1:202A CALLE SAN JUSTO
Mailing Address - Street 2:SUITE 314
Mailing Address - City:OLD SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1711
Mailing Address - Country:US
Mailing Address - Phone:727-629-5280
Mailing Address - Fax:787-629-5279
Practice Address - Street 1:1 RES JARD CAMPO RICO # 877
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3267
Practice Address - Country:US
Practice Address - Phone:787-629-5280
Practice Address - Fax:787-629-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology