Provider Demographics
NPI:1659394047
Name:MODERN NUCLEAR, INC.
Entity Type:Organization
Organization Name:MODERN NUCLEAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LAVERTY
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT, RSO
Authorized Official - Phone:562-905-2244
Mailing Address - Street 1:511 S HARBOR BLVD
Mailing Address - Street 2:BLDG E
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-9375
Mailing Address - Country:US
Mailing Address - Phone:562-905-2244
Mailing Address - Fax:562-905-2024
Practice Address - Street 1:511 S HARBOR BLVD
Practice Address - Street 2:BLDG E
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-9375
Practice Address - Country:US
Practice Address - Phone:562-905-2244
Practice Address - Fax:562-905-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARAML 5179-302471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHB938BMedicare PIN
CATG556AMedicare PIN
CATG556Medicare PIN
CAHB960AMedicare PIN
CAHB938AMedicare PIN
CAHB960BMedicare PIN