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General NPI Number Information
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NPI Number | 1053792135
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Entity Type | Organization
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Legal Business Name | RADIOLOGY SERVICES OF JUPITER MEDICAL SPECIALISTS LLC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 1501 PASADENA AVE S
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-3717
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Country | US
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Telephone | 727-381-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 453128
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City | SUNRISE
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State | FL
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Zip | 33345-3128
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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