Organization
MOLECULAR IMAGING TECHNOLOGIES
Active
Organization
MOLECULAR IMAGING TECHNOLOGIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEROY CANDELARIA (PRESIDENT)
(915) 577-0100
Entity
Organization
Contact information
Practice address
7812 GATEWAY BLVD E STE 120B, EL PASO, TX 79915-1803
(915) 577-0100
(915) 400-0427
Mailing address
7812 GATEWAY BLVD E STE 120B, EL PASO, TX 79915-1803
(915) 577-0100
(915) 533-3664
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123456
—
TX
01
—
1B0565
MEDICARE
TX
Enumeration date
04/03/2018
Last updated
02/22/2024
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