Provider Demographics
NPI:1356463517
Name:JURADO IGLESIAS, ROBERTO P (ARDMS)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:P
Last Name:JURADO IGLESIAS
Suffix:
Gender:M
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22218 SW 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4532
Mailing Address - Country:US
Mailing Address - Phone:786-326-8107
Mailing Address - Fax:561-483-3901
Practice Address - Street 1:6366 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1929
Practice Address - Country:US
Practice Address - Phone:786-326-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARDMS1017562471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography