Healthcare Provider Details

I. General information

NPI: 1831308121
Provider Name (Legal Business Name): JOANNE MARIN FAVALE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ROOSEVELT 156
HATO REY PR
00918
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 647
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-1422
  • Fax: 787-754-8555
Mailing address:
  • Phone: 787-754-1422
  • Fax: 787-754-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: JOANNE M MARIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-754-1422