=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518155944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL ANCILLARY NON INVASIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB. ATENAS CALLE ELLIOT VELEZ J-23 STE 205
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PUERTO RICO
-----------------------------------------------------
Zip | 00674
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 787-854-5704
-----------------------------------------------------
Fax | 787-854-5704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1096
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00674-1096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-5704
-----------------------------------------------------
Fax | 787-854-5704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRADORA
-----------------------------------------------------
Name | MS. ANA L PADILLA ROSA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-854-5704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471C1101X
-----------------------------------------------------
Taxonomy Name | Cardiovascular-Interventional Technology Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------