Healthcare Provider Details

I. General information

NPI: 1811401714
Provider Name (Legal Business Name): IMRAD PR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 AVE PONCE DE LEON PARADA 37.5 PISO 3 HOSPITAL AUXILIO MUTUO
SAN JUAN PR
00919
US

IV. Provider business mailing address

1860 CALLE GLASGOW URB COLLEGE PARK IV
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4836
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCISCO DE LA CRUZ
Title or Position: OWNER
Credential: MD
Phone: 787-370-0242