Provider Demographics
NPI:1104030972
Name:NUCLEAR RADIOLOGY, CSP
Entity Type:Organization
Organization Name:NUCLEAR RADIOLOGY, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAQUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-474-8878
Mailing Address - Street 1:100 GRAN PASEOS BULEVAR
Mailing Address - Street 2:SUITE 112-137
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5905
Mailing Address - Country:US
Mailing Address - Phone:787-474-8878
Mailing Address - Fax:787-771-7445
Practice Address - Street 1:HOSP AUXILIO MUTUO, 715 AVE PONCE DE LEON, PDA 37 1/2
Practice Address - Street 2:EDIF NINO DIVINO JESUS, CENTRO IMAGENES DE LA MUJER
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-474-8878
Practice Address - Fax:787-771-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREC962AOtherPTAN