Provider Demographics
NPI:1922504588
Name:MOLECULAR IMAGING TECHNOLOGIES
Entity Type:Organization
Organization Name:MOLECULAR IMAGING TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-577-0100
Mailing Address - Street 1:7812 GATEWAY BLVD E STE 120B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1803
Mailing Address - Country:US
Mailing Address - Phone:915-577-0100
Mailing Address - Fax:915-533-3664
Practice Address - Street 1:7812 GATEWAY BLVD E STE 120B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1803
Practice Address - Country:US
Practice Address - Phone:915-577-0100
Practice Address - Fax:915-400-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1B0565OtherMEDICARE
TX123456Medicaid