Healthcare Provider Details

I. General information

NPI: 1447524236
Provider Name (Legal Business Name): RIO GRANDE NUCLEAR PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CALLE SAN JUAN ESQ. DEL CARMEN
RIO GRANDE PR
00745-3015
US

IV. Provider business mailing address

PO BOX 1569
RIO GRANDE PR
00745-1569
US

V. Phone/Fax

Practice location:
  • Phone: 787-887-7021
  • Fax: 787-887-3115
Mailing address:
  • Phone: 787-887-7055
  • Fax: 787-887-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENIS F RUIZ-SERRANO
Title or Position: OWNER
Credential: M.D.
Phone: 787-887-7055