Healthcare Provider Details

I. General information

NPI: 1619125960
Provider Name (Legal Business Name): JCN RADIOLOGY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CRUZ ORTIZ STELLA AVENUE
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 9132
HUMACAO PR
00792-9132
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0920
  • Fax: 787-852-7770
Mailing address:
  • Phone: 787-852-0920
  • Fax: 787-852-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number12947
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number12947
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12947
License Number StatePR

VIII. Authorized Official

Name: JOSE R NASSAR
Title or Position: PRESIDENT
Credential: MD
Phone: 787-852-0920