Provider Demographics
NPI:1649607979
Name:VEGA ALTA IMAGING CENTER PSC
Entity type:Organization
Organization Name:VEGA ALTA IMAGING CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEILYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-883-2320
Mailing Address - Street 1:PO BOX 4284
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4284
Mailing Address - Country:US
Mailing Address - Phone:787-983-8431
Mailing Address - Fax:787-883-2320
Practice Address - Street 1:42 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-6530
Practice Address - Country:US
Practice Address - Phone:787-883-2320
Practice Address - Fax:787-883-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology