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General NPI Number Information
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NPI Number | 1417395617
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Entity Type | Organization
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Legal Business Name | MILLENIUM OPEN MRI AND IMAGING CENTER II PSC
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 1501 AVE FERNANDEZ JUNCOS ESQ PAVIA SUITE 101
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City | SAN JUAN
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State | PR
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Zip | 00910
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Country | US
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Telephone | 787-426-5677
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16257
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City | SAN JUAN
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State | PR
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Zip | 00908-6257
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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 | VICE PRESIDENT
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Name | ELIEZER CRESPO
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Credential |
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Telephone | 787-409-0931
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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 | 11391
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License Number State | PR
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