Provider Demographics
NPI:1578516886
Name:BETA GAMMA NUCLEAR RADIOLOGY, INC.
Entity Type:Organization
Organization Name:BETA GAMMA NUCLEAR RADIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ- MONTE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:787-801-0092
Mailing Address - Street 1:P.M.B. 372 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:787-801-0092
Mailing Address - Fax:787-801-0094
Practice Address - Street 1:CARIBBEAN MEDICAL CENTER OFFICE 101
Practice Address - Street 2:OSVALDO MOLINA AVE. # 151
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-801-0092
Practice Address - Fax:787-801-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR01-084261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0053474Medicare ID - Type UnspecifiedPROVIDER #