Healthcare Provider Details

I. General information

NPI: 1922347376
Provider Name (Legal Business Name): NUSCAN AIBONITO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CALLE JOSE C VAZQUEZ
AIBONITO PR
00705-3309
US

IV. Provider business mailing address

PO BOX 6960
CAGUAS PR
00726-6960
US

V. Phone/Fax

Practice location:
  • Phone: 787-744-5278
  • Fax:
Mailing address:
  • Phone: 787-744-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number9549
License Number StatePR

VIII. Authorized Official

Name: DR. HIRAM RIVERA LUNA
Title or Position: DIRECTOR
Credential: MD
Phone: 787-744-5278