NPIMap

Organization Active NPI

Fajardo Imaging MRI CSP

  • Mammography Clinic/Center
  • Rio Grande, PR
National Provider Identifier
1295896587
Registry record updated Sep 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
License
5767 Issued in PR
Legal business name
FAJARDO IMAGING MRI CSP
Practice address
Ave Agustin Perez Andino B-30
Villas de Rio Grande
Rio Grande, PR 00745
Phone
(787) 887-5944
Fax
(787) 887-7917
NPI assigned
Dec 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Diana Fernadez Garcia, M.D.
Title
Radiologist
Phone
(787) 860-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mammography Clinic/Center 261QR0206X 5767 PR Primary

Addresses

Primary practice location

Ave Agustin Perez Andino B-30
Villas de Rio Grande
Rio Grande, PR 00745

Mailing address

PO Box 490
Puerto Real, PR 00740
Phone (787) 860-3400

Other names 1

  • FAJARDO IMAGING MRI CSP Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111122000471 PR Part B Supplier - Clinic/Group Practice 2466626791 Receives reassigned benefits from 2 practitioners
Practice locations: Rio Grande, PR

National Provider Directory

National Provider Directory

Locations

B30 Ave a Perez Andino
Rio Grande, PR 00745
Phone (787) 887-5944

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316563200000",
    "number": "1295896587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "PUERTO REAL",
            "state": "PR",
            "postal_code": "00740",
            "telephone_number": "787-860-3400",
            "fax_number": "787-863-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "AVE AGUSTIN PEREZ ANDINO B-30",
            "address_2": "VILLAS DE RIO GRANDE",
            "city": "RIO GRANDE",
            "state": "PR",
            "postal_code": "00745",
            "telephone_number": "787-887-5944",
            "fax_number": "787-887-7917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAJARDO IMAGING MRI CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2011-09-21",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "FERNADEZ",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "787-860-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "PR",
            "license": "5767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAJARDO IMAGING MRI CSP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rio Grande, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.