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General NPI Number Information
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NPI Number | 1205232923
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Entity Type | Organization
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Legal Business Name | NAHUEL IMAGE CENTER
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 1700 N STATE ST SUITE 16
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City | PROVO
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State | UT
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Zip | 84604-1011
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Country | US
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Telephone | 801-822-5644
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Fax | 888-258-9831
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Provider Business Mailing Address
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Address Line | 1700 N STATE ST SUITE 16
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City | PROVO
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State | UT
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Zip | 84604-1011
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Country | US
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Telephone | 801-822-5644
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Fax | 888-258-9831
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARIANO REGINATO
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Credential |
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Telephone | 970-250-6170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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