Healthcare Provider Details

I. General information

NPI: 1962471599
Provider Name (Legal Business Name): NUCLEAR CARDIOLOGY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1396 SAN FAFAEL ST MEDICAL PAVILION SUITE 16
SAN JUAN PR
00909-2526
US

IV. Provider business mailing address

1396 SAN FAFAEL ST MEDICAL PAVILION SUITE 16
SAN JUAN PR
00909-2526
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-0700
  • Fax: 787-725-5210
Mailing address:
  • Phone: 787-725-0700
  • Fax: 787-725-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5544
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number8643
License Number StatePR

VIII. Authorized Official

Name: DR. MARCOS DEVARIE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-725-0700