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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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