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General NPI Number Information
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NPI Number | 1447662622
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Entity Type | Organization
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Legal Business Name | GM IMAGE GUIDED MEDICINE PSC
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | CARR 349 KM 2.7 CERRO LAS MESAS
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City | MAYAGUEZ
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State | PR
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Zip | 00680
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Country | US
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Telephone | 787-652-6001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4499
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City | MAYAGUEZ
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State | PR
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Zip | 00681-4499
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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 | PRESIDENT
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Name | DR. GABRIEL OSCAR MONAGAS PAGAN
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Credential | M.D.
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Telephone | 787-652-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 16960
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License Number State | PR
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