MEDICARE: ROBERTO P JURADO IGLESIAS ARDMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471S1302X	Sonography Radiologic Technologist	ARDMS101756

General Provider Information

NPI Number	:	1356463517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO P JURADO IGLESIAS ARDMS

Provider Business Mailing Address
First Line	:	22218 SW 58TH AVE
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4532
Country	:	US
Telephone Number	:	786-326-8107
Fax Number	:	561-483-3901

Provider Business Practice Location Address
First Line	:	6366 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1929
Country	:	US
Telephone Number	:	786-326-8107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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