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General NPI Number Information
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NPI Number | 1750645107
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Entity Type | Organization
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Legal Business Name | MODERN RADIOLOGY, PSC
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Dates
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Enumeration Date | 06/30/2012
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Last Update Date | 06/30/2012
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Provider Practice Location Address
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Address Line | 300 AVE FELISA RINCON 72 VISTAS SHOPPING VILLAGE
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City | SAN JUAN
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State | PR
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Zip | 00926-6088
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Country | US
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Telephone | 787-709-4337
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 7346
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City | PONCE
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State | PR
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Zip | 00732-7346
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Country | US
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Telephone | 787-709-4337
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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. GAMALIER BERMUDEZ RUIZ
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Credential | MD
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Telephone | 787-848-8834
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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 | RX4816
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License Number State | PR
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