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General NPI Number Information
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NPI Number | 1962471599
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Entity Type | Organization
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Legal Business Name | NUCLEAR CARDIOLOGY IMAGING
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 1396 SAN FAFAEL ST MEDICAL PAVILION SUITE 16
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City | SAN JUAN
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State | PR
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Zip | 00909-2526
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Country | US
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Telephone | 787-725-0700
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Fax | 787-725-5210
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Provider Business Mailing Address
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Address Line | 1396 SAN FAFAEL ST MEDICAL PAVILION SUITE 16
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City | SAN JUAN
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State | PR
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Zip | 00909-2526
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Country | US
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Telephone | 787-725-0700
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Fax | 787-725-5210
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCOS DEVARIE
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Credential | M.D.
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Telephone | 787-725-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5544
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 8643
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License Number State | PR
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