Provider Demographics
NPI:1710211529
Name:ADVANCED TECHNONUCLEAR IMAGING CENTER INC
Entity Type:Organization
Organization Name:ADVANCED TECHNONUCLEAR IMAGING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-548-0035
Mailing Address - Street 1:525 AVE FD ROOSEVELT
Mailing Address - Street 2:SUITE 401, LA TORRE DE PLAZA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-8001
Mailing Address - Country:US
Mailing Address - Phone:787-237-0554
Mailing Address - Fax:787-282-0472
Practice Address - Street 1:525 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 401, LA TORRE DE PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-237-0554
Practice Address - Fax:787-282-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11861207R00000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG42147Medicare UPIN