Healthcare Provider Details

I. General information

NPI: 1427338706
Provider Name (Legal Business Name): PONCE NUCLEAR MEDICINE, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 BYPASS HOSPITAL DAMAS
PONCE PR
00717-1318
US

IV. Provider business mailing address

PO BOX 9570
CAGUAS PR
00726-9570
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8686
  • Fax:
Mailing address:
  • Phone: 787-922-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENE BAEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-922-8418