1679849368 NPI number — COMPREHENSIVE NUCLEAR & DIAGNOSTIC RADIOLOGY SERVICE, LLC

Table of content: (NPI 1679849368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679849368 NPI number — COMPREHENSIVE NUCLEAR & DIAGNOSTIC RADIOLOGY SERVICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE NUCLEAR & DIAGNOSTIC RADIOLOGY SERVICE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679849368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 355
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7006 CALLE BEGONIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682-1287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-439-7739
Provider Business Practice Location Address Fax Number:
187-788-0234
Provider Enumeration Date:
03/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA RODRIGUEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
RADIOLOGY
Authorized Official Telephone Number:
787-439-7739

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com