Basic Information
| Provider Information | |||||||||
| NPI: | 1740221167 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PET IMAGING RADIOLOGY PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1186 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009601186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872692442 | ||||||||
| FaxNumber: | 7877800143 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PASEO SAN PABLO | ||||||||
| Address2: | SUITE 208 EDIFICIO DR. ARTURO CADILLA | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009617019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872692442 | ||||||||
| FaxNumber: | 7877800143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | QUINONES | ||||||||
| AuthorizedOfficialFirstName: | MYRNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7872692442 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0904X | PR2006-04 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology |
No ID Information.