Healthcare Provider Details

I. General information

NPI: 1750377552
Provider Name (Legal Business Name): NATIONAL NUCLEAR CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOLLYWOOD BLVD
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

4224 HOLLYWOOD BLVD
HOLLYWOOD FL
33021
US

V. Phone/Fax

Practice location:
  • Phone: 954-966-3600
  • Fax: 954-967-1962
Mailing address:
  • Phone: 954-966-3600
  • Fax: 954-967-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC3753
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCCR3753
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberHCC8933
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberHCC3753
License Number StateFL

VIII. Authorized Official

Name: MR. ANGEL L SOTO JR.
Title or Position: PRESIDENT
Credential:
Phone: 954-966-3600