Organization
KARDIONUCLEAR PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CONFESOR LASALLE-RUIZ MD (PRESIDENT)
(787) 551-0215
Entity
Organization
Contact information
Practice address
550 CALLE CONCEPCION, HOSP SAN CARLOS DE BORROMEO 1 PISO, MOCA, PR 00676
(787) 551-0215
(787) 551-0214
Mailing address
PO BOX 976, QUEBRADILLAS, PR 00678-0976
(787) 551-0215
(787) 551-0214
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
7172
PR
207U00000X
Nuclear Medicine Physician
11046
PR
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51220-02
ACR
PR
01
—
52-35164-01
NRC
PR
Enumeration date
08/04/2010
Last updated
05/08/2015
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