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General NPI Number Information
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NPI Number | 1750601183
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Entity Type | Organization
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Legal Business Name | PONCE MEDICAL IMAGING
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 1326 CALLE SALUD EL SENORIAL PLAZA 105
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City | PONCE
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State | PR
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Zip | 00717-1686
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Country | US
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Telephone | 787-840-3395
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Fax | 787-844-2664
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Provider Business Mailing Address
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Address Line | PO BOX 720
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City | MERCEDITA
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State | PR
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Zip | 00715-0720
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Country | US
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Telephone | 787-840-3395
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Fax | 787-844-2664
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIGUEL A. ECHEVARRIA
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Credential | MD
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Telephone | 787-840-3395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 6047
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License Number State | PR
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