Provider Demographics
NPI:1245778778
Name:AKBUR, OWANNA
Entity Type:Individual
Prefix:
First Name:OWANNA
Middle Name:
Last Name:AKBUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 BOLIVAR AVE., TORRE G-32
Mailing Address - Street 2:APT. A-2
Mailing Address - City:LA ESPERILLA
Mailing Address - State:SANTO DOMINGO
Mailing Address - Zip Code:12305
Mailing Address - Country:DO
Mailing Address - Phone:809-889-9780
Mailing Address - Fax:
Practice Address - Street 1:752 BOLIVAR AVE., TORRE G-32
Practice Address - Street 2:APT. A-2
Practice Address - City:LA ESPERILLA
Practice Address - State:SANTO DOMINGO
Practice Address - Zip Code:12305
Practice Address - Country:DO
Practice Address - Phone:809-889-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5005149382471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging