Provider Demographics
NPI:1952587578
Name:MAYAGUEZ NUCLEAR PET CENTER
Entity type:Organization
Organization Name:MAYAGUEZ NUCLEAR PET CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARACELI
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-6300
Mailing Address - Street 1:PO BOX 6468
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6468
Mailing Address - Country:US
Mailing Address - Phone:787-834-6300
Mailing Address - Fax:787-834-6203
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:SUITE 205
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-834-6300
Practice Address - Fax:787-834-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty