Provider Demographics
NPI:1447524236
Name:RIO GRANDE NUCLEAR PSC
Entity type:Organization
Organization Name:RIO GRANDE NUCLEAR PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUIZ-SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-887-7055
Mailing Address - Street 1:PO BOX 1569
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-1569
Mailing Address - Country:US
Mailing Address - Phone:787-887-7055
Mailing Address - Fax:787-887-3115
Practice Address - Street 1:13 CALLE SAN JUAN
Practice Address - Street 2:ESQ. DEL CARMEN
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-3015
Practice Address - Country:US
Practice Address - Phone:787-887-7021
Practice Address - Fax:787-887-3115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPARRA CARDIOLOGY AND ELECTROPHYSIOLOGY CENTER PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-27
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR120998OtherIAC ACCREDITATION