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General NPI Number Information
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NPI Number | 1255630380
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Entity Type | Organization
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Legal Business Name | MMD ADVANCED IMAGING, PSC
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 05/29/2016
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Provider Practice Location Address
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Address Line | PLAZA LAS AMERICAS TOWER SUITE 905
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-620-4316
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Fax |
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Provider Business Mailing Address
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Address Line | PLAZA LAS AMERICAS TOWER SUITE 905
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-620-4316
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAYRA MALDONADO-DURAN
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Credential | MD
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Telephone | 787-250-8985
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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 | 17175
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License Number State | PR
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