Healthcare Provider Details

I. General information

NPI: 1679415442
Provider Name (Legal Business Name): NUVISTA IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5363 COMMERCE BLVD STE B
CROWN POINT IN
46307-5325
US

IV. Provider business mailing address

5363 COMMERCE BLVD STE B
CROWN POINT IN
46307-5325
US

V. Phone/Fax

Practice location:
  • Phone: 219-306-0257
  • Fax: 630-780-2535
Mailing address:
  • Phone: 219-306-0257
  • Fax: 630-780-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SERGIO A DE LA TORRE
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 575-312-9990