Provider Demographics
NPI:1962471599
Name:NUCLEAR CARDIOLOGY IMAGING
Entity Type:Organization
Organization Name:NUCLEAR CARDIOLOGY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVARIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-725-0700
Mailing Address - Street 1:1396 SAN FAFAEL ST
Mailing Address - Street 2:MEDICAL PAVILION SUITE 16
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2526
Mailing Address - Country:US
Mailing Address - Phone:787-725-0700
Mailing Address - Fax:787-725-5210
Practice Address - Street 1:1396 SAN FAFAEL ST
Practice Address - Street 2:MEDICAL PAVILION SUITE 16
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2526
Practice Address - Country:US
Practice Address - Phone:787-725-0700
Practice Address - Fax:787-725-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5544207RC0000X
PR8643207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-4877Medicare ID - Type Unspecified