Provider Demographics
NPI:1144380999
Name:PET DIAGNOSTIC IMAGING CORP
Entity Type:Organization
Organization Name:PET DIAGNOSTIC IMAGING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-842-2478
Mailing Address - Street 1:2225 PONCE BY PASS PARRA BUILDING
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1320
Mailing Address - Country:US
Mailing Address - Phone:787-259-8420
Mailing Address - Fax:787-841-2818
Practice Address - Street 1:2225 PONCE BY PASS PARRA BUILDING
Practice Address - Street 2:SUITE 103
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1320
Practice Address - Country:US
Practice Address - Phone:787-259-8420
Practice Address - Fax:787-841-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology