Provider Demographics
NPI:1801065610
Name:LAB MEDICINA NUCLEAR PSC
Entity type:Organization
Organization Name:LAB MEDICINA NUCLEAR PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-751-4222
Mailing Address - Street 1:PMB 382 1353 RD 19
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-751-4222
Mailing Address - Fax:787-751-4180
Practice Address - Street 1:1ST PISO CENTRO CARDIOVASCULAR
Practice Address - Street 2:CENTRO MEDICA
Practice Address - City:SJ
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-751-4222
Practice Address - Fax:787-751-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR111046207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR56629Medicare UPIN
0020885Medicare Oscar/Certification