Provider Demographics
NPI:1255630380
Name:MMD ADVANCED IMAGING, PSC
Entity type:Organization
Organization Name:MMD ADVANCED IMAGING, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO-DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-250-8985
Mailing Address - Street 1:PLAZA LAS AMERICAS TOWER
Mailing Address - Street 2:SUITE 905
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-620-4316
Mailing Address - Fax:
Practice Address - Street 1:PLAZA LAS AMERICAS TOWER
Practice Address - Street 2:SUITE 905
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-620-4316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR171752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty