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General NPI Number Information
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NPI Number | 1346582152
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL COMPONENT INC
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 4007 ESTATE DIAMOND RUBY
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City | CHRISTIANSTED
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State | VI
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Zip | 00820-4435
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Country | US
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Telephone | 340-778-5305
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 49009
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City | GREENWOOD
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State | SC
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Zip | 29649-0001
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Country | US
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Telephone | 864-223-3070
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Fax | 864-223-1396
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Authorized Official
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Title or Position | MD
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Name | ANGELO K GALIBER
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Credential | MD
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Telephone | 340-778-5305
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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 | 784
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License Number State | VI
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