Healthcare Provider Details

I. General information

NPI: 1356463517
Provider Name (Legal Business Name): ROBERTO P JURADO IGLESIAS ARDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6366 CORAL WAY
MIAMI FL
33155-1929
US

IV. Provider business mailing address

22218 SW 58TH AVE
BOCA RATON FL
33428-4532
US

V. Phone/Fax

Practice location:
  • Phone: 786-326-8107
  • Fax:
Mailing address:
  • Phone: 786-326-8107
  • Fax: 561-483-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberARDMS101756
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: