Provider Demographics
NPI:1962737387
Name:PROVIDENCE DIAGNOSTIC AND MEDICAL CENTER INC
Entity type:Organization
Organization Name:PROVIDENCE DIAGNOSTIC AND MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-522-5201
Mailing Address - Street 1:1400 CALLE SAN RAFAEL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2693
Mailing Address - Country:US
Mailing Address - Phone:787-522-5201
Mailing Address - Fax:787-552-5207
Practice Address - Street 1:1400 CALLE SAN RAFAEL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2693
Practice Address - Country:US
Practice Address - Phone:787-522-5201
Practice Address - Fax:787-552-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-04
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty