Basic Information
| Provider Information | |||||||||
| NPI: | 1770987463 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN PABLO DEVELOPERS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED IMAGING INTERVENTIONAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1186 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009601186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872692442 | ||||||||
| FaxNumber: | 7877859558 | ||||||||
| Practice Location | |||||||||
| Address1: | CENTRO MEDICO SAN PABLO | ||||||||
| Address2: | EDIFICIO DR ARTURO CADILLA, SUITE 102 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872692442 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2014 | ||||||||
| LastUpdateDate: | 10/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | MIRANDA | ||||||||
| AuthorizedOfficialFirstName: | BEATRIZ | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7872692442 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 2 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.