Healthcare Provider Details

I. General information

NPI: 1093999070
Provider Name (Legal Business Name): F&M RADIOLOGIST, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 AVE GEN VALERO
FAJARDO PR
00738-4848
US

IV. Provider business mailing address

#316 GENERAL VALERO AVENUE
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-3400
  • Fax: 787-863-2075
Mailing address:
  • Phone: 787-860-3400
  • Fax: 787-863-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StatePR

VIII. Authorized Official

Name: RODRIGUEZ NEVELLY
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-860-3400