Provider Demographics
NPI:1568415867
Name:P.E.T. NUCLEAR RADIOLOGY, INC.
Entity Type:Organization
Organization Name:P.E.T. NUCLEAR RADIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:PEREZ-MONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-727-2738
Mailing Address - Street 1:P.M.B. 322 P.O. BOX 7891
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970
Mailing Address - Country:US
Mailing Address - Phone:787-727-2738
Mailing Address - Fax:787-728-4799
Practice Address - Street 1:EDIFICIO BETANCOURT SUITE 302
Practice Address - Street 2:FERNNDEZ JUNCOS AVE. # 1501
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-727-2738
Practice Address - Fax:787-728-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05-126261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology