Healthcare Provider Details

I. General information

NPI: 1588857833
Provider Name (Legal Business Name): PLAZA NUCLEAR IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE FD ROOSEVELT LA TORRE DE PLAZA SUITE 401
SAN JUAN PR
00918-8001
US

IV. Provider business mailing address

ESMERALDA AVE 53 CORREO ESMERALDA PMB 114
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-0715
  • Fax: 787-282-0472
Mailing address:
  • Phone:
  • Fax: 787-282-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberPR-2001-23
License Number StatePR

VIII. Authorized Official

Name: DR. FRIEDA SILVA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-754-0715