Healthcare Provider Details

I. General information

NPI: 1023273752
Provider Name (Legal Business Name): MAYAGUEZ NUCLEAR PET CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 AVE HOSTOS MEDICAL EMPORIUM SUITE 205
MAYAGUEZ PR
00680-1502
US

IV. Provider business mailing address

PO BOX 6468
MAYAGUEZ PR
00681-6468
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-6300
  • Fax: 787-834-6203
Mailing address:
  • Phone: 787-834-6300
  • Fax: 787-834-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number8827
License Number StatePR

VIII. Authorized Official

Name: DR. ARACELI RIVERA SERRANO
Title or Position: DOCTOR
Credential:
Phone: 787-834-6300