Organization
PREMIER NUCLEAR MEDICINE CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA E ACEVEDO MD (PRESIDENT)
(787) 402-0100
Entity
Organization
Contact information
Practice address
HOSPITAL RYDER MEMORIAL, 355 CALLE FONT MARTELO, HUMACAO, PR 00791-3249
(787) 850-2012
(787) 850-2012
Mailing address
URBANIZACION SANTA ROSA, CALLE 9 BLQ 17 NO 17, BAYAMON, PR 00959-6606
(787) 402-0100
(787) 294-6099
Taxonomy
Speciality
Code
Description
License number
State
207UN0902X
Nuclear Imaging & Therapy Physician
Primary
10641
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FC340A
MEDICARE PTAN
PR
Enumeration date
09/19/2011
Last updated
06/01/2020
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