Healthcare Provider Details

I. General information

NPI: 1811456858
Provider Name (Legal Business Name): IMAGENES DINAMICAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 CALLE ONEILL STE A
SAN JUAN PR
00918-2410
US

IV. Provider business mailing address

PO BOX 16120
SAN JUAN PR
00908-6120
US

V. Phone/Fax

Practice location:
  • Phone: 787-405-8519
  • Fax:
Mailing address:
  • Phone: 787-405-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. PABLO LITVACHKES
Title or Position: PRESIDENT
Credential:
Phone: 787-405-8519