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General NPI Number Information
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NPI Number | 1063650893
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Entity Type | Organization
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Legal Business Name | JK RADIOLOGY SERVICES, CSP
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | TRUJILLO MEDICAL BUILDING SUITE 202-203 EXPRESO TRUJILLO ALTO KM. 2.1
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-293-4641
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Fax | 787-748-2840
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Provider Business Mailing Address
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Address Line | PO BOX 41071
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City | SAN JUAN
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State | PR
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Zip | 00940-1071
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Country | US
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Telephone | 787-293-4641
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Fax | 787-748-2840
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEANNINE M. BADILLO
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Credential | MD
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Telephone | 787-293-4641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 12086
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License Number State | PR
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