Healthcare Provider Details

I. General information

NPI: 1134322795
Provider Name (Legal Business Name): OVED OQUENDO L, RT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

13618 39TH AVE SUITE 906
FLUSHING NY
11354-5516
US

IV. Provider business mailing address

13618 39TH AVE SUITE 906
FLUSHING NY
11354-5516
US

V. Phone/Fax

Practice location:
  • Phone: 718-961-8817
  • Fax: 718-961-8815
Mailing address:
  • Phone: 718-961-8817
  • Fax: 718-961-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number104667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: