# INNOVATIVE INTERVENTIONAL RADIOLOGY IMAGING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710299722
- **Authorized official:** MRS. IVELISSE CANCEL MHSA (VICEPRESIDENT/ADMINISTRATOR)
- **Authorized official phone:** (787) 487-6096

## Contact information

- **Practice address:** COND ANDREAS COURT, 370 CALLE 10 APT 146, TRUJILLO ALTO, PR 00976
- **Practice address phone:** (787) 761-7477
- **Mailing address:** COND ANDREAS COURT, 370 CALLE 10 APT 146, TRUJILLO ALTO, PR 00976
- **Mailing address phone:** (787) 761-7477

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | 14053 | PR | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | 14053 | PR | Yes |

## Other

- **Enumeration date:** 07/07/2010
- **Last updated:** 07/07/2010