Healthcare Provider Details

I. General information

NPI: 1265745129
Provider Name (Legal Business Name): NUCMED, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CALLE SANTA CRUZ
BAYAMON PR
00961-7052
US

IV. Provider business mailing address

1652 CALLE SANTA AGUEDA LE CHALET COURT B4
SAN JUAN PR
00926-4135
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-4747
  • Fax:
Mailing address:
  • Phone: 787-620-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number13721
License Number StatePR

VIII. Authorized Official

Name: DR. CESAR OSCAR BORRI
Title or Position: NUCLEAR MEDICINE
Credential: M.D
Phone: 787-365-7166