Healthcare Provider Details

I. General information

NPI: 1144349143
Provider Name (Legal Business Name): MJ IMAGING CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARETERA 153 KM7.8 PLAZA SANTA ISABEL
SANTA ISABEL PR
00757-3801
US

IV. Provider business mailing address

160 CALLE FLAMBOYAN VALLE ARRIBA
COAMO PR
00769-3647
US

V. Phone/Fax

Practice location:
  • Phone: 787-608-4397
  • Fax:
Mailing address:
  • Phone: 787-608-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number06162
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number06162
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number06162
License Number StatePR

VIII. Authorized Official

Name: MR. MISAEL RIVERA
Title or Position: PRESIDENT
Credential:
Phone: 787-608-4397