Organization
MODERN RADIOLOGY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAMALIER BERMUDEZ RUIZ MD (PRESIDENT)
(787) 848-8834
Entity
Organization
Contact information
Practice address
300 AVE FELISA RINCON, 72 VISTAS SHOPPING VILLAGE, SAN JUAN, PR 00926-6088
(787) 709-4337
Mailing address
P O BOX 7346, PONCE, PR 00732-7346
(787) 709-4337
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
RX4816
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306804752
NPI
PR
01
—
RX4816
PROVIDER LICENSE NUMBER
PR
Enumeration date
06/30/2012
Last updated
06/30/2012
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