Provider Demographics
NPI:1578547196
Name:DIAGNOSTIC NUCLEAR MEDICINE
Entity Type:Organization
Organization Name:DIAGNOSTIC NUCLEAR MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-891-2175
Mailing Address - Street 1:PO BOX 3643
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3643
Mailing Address - Country:US
Mailing Address - Phone:787-891-2175
Mailing Address - Fax:787-891-2175
Practice Address - Street 1:LOBBY HOSPITAL BUEN SAMARITANO
Practice Address - Street 2:AVE SEVERIANO CUEVAS 18
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-891-2175
Practice Address - Fax:787-891-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11830174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10384Medicare ID - Type Unspecified