Healthcare Provider Details

I. General information

NPI: 1831134626
Provider Name (Legal Business Name): MEDICAL DIAGNOSTIC PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 AVE PONCE DE LEON SUITE 304
SAN JUAN PR
00907-4037
US

IV. Provider business mailing address

1311 AVE PONCE DE LEON SUITE 304
SAN JUAN PR
00907-4037
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-0127
  • Fax:
Mailing address:
  • Phone: 787-722-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number0057543
License Number StatePR

VIII. Authorized Official

Name: GEEIDYS T RUIZ
Title or Position: PRESIDENT
Credential: NA
Phone: 787-722-0127