Healthcare Provider Details

I. General information

NPI: 1740221167
Provider Name (Legal Business Name): PET IMAGING RADIOLOGY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASEO SAN PABLO SUITE 208 EDIFICIO DR. ARTURO CADILLA
BAYAMON PR
00961-7019
US

IV. Provider business mailing address

PO BOX 1186
BAYAMON PR
00960-1186
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-2442
  • Fax: 787-780-0143
Mailing address:
  • Phone: 787-269-2442
  • Fax: 787-780-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberPR2006-04
License Number StatePR

VIII. Authorized Official

Name: MRS. MYRNA QUINONES
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 787-269-2442