Provider Demographics
NPI:1497871818
Name:CRESPO, AGNES AIMMEE (MT)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:AIMMEE
Last Name:CRESPO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 CALLE CARLOS BERTERO
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3440
Mailing Address - Country:US
Mailing Address - Phone:787-276-0709
Mailing Address - Fax:
Practice Address - Street 1:1143 CALLE CARLOS BERTERO
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3440
Practice Address - Country:US
Practice Address - Phone:787-276-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2695246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist