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Organization
INNOVATIVE INTERVENTIONAL RADIOLOGY IMAGING
Active
Organization
INNOVATIVE INTERVENTIONAL RADIOLOGY IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IVELISSE CANCEL MHSA (VICEPRESIDENT/ADMINISTRATOR)
(787) 487-6096
Entity
Organization
Contact information
Practice address
COND ANDREAS COURT, 370 CALLE 10 APT 146, TRUJILLO ALTO, PR 00976
(787) 761-7477
Mailing address
COND ANDREAS COURT, 370 CALLE 10 APT 146, TRUJILLO ALTO, PR 00976
(787) 761-7477
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
14053
PR
2085R0204X
Vascular & Interventional Radiology Physician
Primary
14053
PR
Other
Enumeration date
07/07/2010
Last updated
07/07/2010
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