Healthcare Provider Details

I. General information

NPI: 1376488866
Provider Name (Legal Business Name): DANIA LASALLE IGARTUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 KM 1.O AVE. SAN LUIS
ARECIBO PR
00613
US

IV. Provider business mailing address

PO BOX 1247
QUEBRADILLAS PR
00678-1247
US

V. Phone/Fax

Practice location:
  • Phone: 727-412-2719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: