Basic Information
| Provider Information | |||||||||
| NPI: | 1588782437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OJEDA BOSCANA | ||||||||
| FirstName: | IVONNE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | RECINTO DE CIENCIAS MEDICAS (UPR-RCM/RADIOLOGIA) | ||||||||
| Address2: | EDIFICIO PRINCIPAL RCM-UPR, P.O BOX 29134 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877773855 | ||||||||
| Practice Location | |||||||||
| Address1: | ADMINISTRACION SERVICIOS MEDICOS DE PUERTO RICO | ||||||||
| Address2: | RCM-RADIOLOGIA, CARR. 22, BO. MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877773855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 02/17/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 9253 | PR | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 9253 | 01 | PR | PUERTO RICO MEDICAL LICENSE | OTHER | 9253 | 01 | PR | PUERTO RICO | OTHER |