Healthcare Provider Details

I. General information

NPI: 1497871818
Provider Name (Legal Business Name): AGNES AIMMEE CRESPO M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 CALLE CARLOS BERTERO URB. COUNTRY CLUB
SAN JUAN PR
00924-3440
US

IV. Provider business mailing address

1143 CALLE CARLOS BERTERO URB. COUNTRY CLUB
SAN JUAN PR
00924-3440
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-0709
  • Fax:
Mailing address:
  • Phone: 787-276-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number2695
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: