Healthcare Provider Details

I. General information

NPI: 1588989743
Provider Name (Legal Business Name): IMI OF SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 AVE FERNANDEZ JUNCOS
SANTURCE PR
00909-2655
US

IV. Provider business mailing address

1448 AVE FERNANDEZ JUNCOS
SANTURCE PR
00909-2655
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-7776
  • Fax: 787-721-7774
Mailing address:
  • Phone: 787-721-7776
  • Fax: 787-721-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. NIVIA SOUFFRONT
Title or Position: CENTER DIRECTOR
Credential:
Phone: 787-721-7776