Healthcare Provider Details

I. General information

NPI: 1235409210
Provider Name (Legal Business Name): GRUPO RADIOLOGICO DR JAVIER JAVIER ANTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. PINEIRO ESQ.VALLEJO #1 RIO PIEDRAS
SAN JUAN PR
00928
US

IV. Provider business mailing address

AVE. PINEIRO ESQ.VALLEJO #1 RIO PIEDRAS
SAN JUAN PR
00928
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3841
  • Fax: 787-977-0544
Mailing address:
  • Phone: 787-480-3841
  • Fax: 787-977-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number8
License Number StatePR

VIII. Authorized Official

Name: MARITZA VEGA DE JESUS
Title or Position: EXECUTIVE SUB DIRECTOR
Credential: MBH HCM
Phone: 787-480-3841