Healthcare Provider Details

I. General information

NPI: 1992944136
Provider Name (Legal Business Name): SOUTHERN MEDICAL IMAGING, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CALLE ISABEL MANSION REAL
COTO LAUREL PR
00780-2601
US

IV. Provider business mailing address

227 CALLE ISABEL MANSION REAL
COTO LAUREL PR
00780-2601
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-4624
  • Fax:
Mailing address:
  • Phone: 787-848-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number15370
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number15370
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number15370
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License Number15370
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number15370
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADRIAN A. ALVAREZ DE LA CAMPA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-848-4624