1568415867 NPI number — P.E.T. NUCLEAR RADIOLOGY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568415867 NPI number — P.E.T. NUCLEAR RADIOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P.E.T. NUCLEAR RADIOLOGY, INC.
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:
1568415867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.M.B. 322 P.O. BOX 7891
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-727-2738
Provider Business Mailing Address Fax Number:
787-728-4799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO BETANCOURT SUITE 302
Provider Second Line Business Practice Location Address:
FERNNDEZ JUNCOS AVE. # 1501
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-727-2738
Provider Business Practice Location Address Fax Number:
787-728-4799
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ-MONTE
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
ENRIQUE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-727-2738

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  05-126 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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