Provider Demographics
NPI:1043522006
Name:INSTITUTO ULTRASONIDO Y MAMOGRAFIA
Entity type:Organization
Organization Name:INSTITUTO ULTRASONIDO Y MAMOGRAFIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-837-3312
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0720
Mailing Address - Country:US
Mailing Address - Phone:787-837-3312
Mailing Address - Fax:787-837-3285
Practice Address - Street 1:107 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1646
Practice Address - Country:US
Practice Address - Phone:787-837-3312
Practice Address - Fax:787-837-3285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSTITUTO ULTRASONIDO Y MAMOGRAFIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79685Medicare UPIN
PR0027653Medicare PIN