Healthcare Provider Details

I. General information

NPI: 1306887914
Provider Name (Legal Business Name): JR MEDICAL DIAGNOSTIC SERVICES.CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 AVE PONCE DE LEON SUITE 301
SAN JUAN PR
00907-4037
US

IV. Provider business mailing address

1311 AVE PONCE DE LEON SUITE 301
SAN JUAN PR
00907-4037
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-7235
  • Fax: 787-723-1369
Mailing address:
  • Phone: 787-722-7235
  • Fax: 787-723-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number0031182
License Number StatePR

VIII. Authorized Official

Name: JOSSUE A GALGUERA
Title or Position: PRESIDENT
Credential: NA
Phone: 787-722-7235