MEDICARE: RIO GRANDE NUCLEAR PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207UN0901X	Nuclear Cardiology Physician
2	207U00000X	Nuclear Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120998	OTHER	PR	IAC ACCREDITATION

General Provider Information

NPI Number	:	1447524236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIO GRANDE NUCLEAR PSC

Provider Business Mailing Address
First Line	:	PO BOX 1569
Second Line	:
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-1569
Country	:	US
Telephone Number	:	787-887-7055
Fax Number	:	787-887-3115

Provider Business Practice Location Address
First Line	:	13 CALLE SAN JUAN
Second Line	:	ESQ. DEL CARMEN
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-3015
Country	:	US
Telephone Number	:	787-887-7021
Fax Number	:	787-887-3115

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DENIS F RUIZ-SERRANO
Credential	:	M.D.
Telephone Number	:	787-887-7055

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/29/2012

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