Provider Demographics
NPI:1578522132
Name:INSTITUTO MEDICINA NUCLEAR
Entity Type:Organization
Organization Name:INSTITUTO MEDICINA NUCLEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:SOLTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-919-7172
Mailing Address - Street 1:PO BOX 364367
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4367
Mailing Address - Country:US
Mailing Address - Phone:787-919-7172
Mailing Address - Fax:787-727-5574
Practice Address - Street 1:1801 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1900
Practice Address - Country:US
Practice Address - Phone:787-726-0440
Practice Address - Fax:787-727-5574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DIAGNOSTICO INTEGRAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080091Medicare PIN