Healthcare Provider Details

I. General information

NPI: 1043287055
Provider Name (Legal Business Name): M & P RADIOLOGOS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANUEL PAVIA STREET 617
SAN JUAN PR
00909
US

IV. Provider business mailing address

PO BOX 8040
SAN JUAN PR
00910-0040
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-5381
  • Fax: 787-727-1477
Mailing address:
  • Phone: 787-727-5381
  • Fax: 787-727-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. MANUEL R PEREZ
Title or Position: ADMINISTRATIVE PARTNER
Credential: M.D.
Phone: 787-727-5381