1679712020 NPI number — KARDIOGAMM NUCLEAR IMAGING, PSC

Table of content: (NPI 1679712020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679712020 NPI number — KARDIOGAMM NUCLEAR IMAGING, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARDIOGAMM NUCLEAR IMAGING, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679712020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THE FALLS APT. 303
Provider Second Line Business Mailing Address:
#2 CARR 177
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARIBBEAN CINEMAS BUILDING
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-239-3800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
BARTOLO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-239-3800

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  13526 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 16235 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207U00000X , with the licence number: 13526 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207U00000X , with the licence number: 16235 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)