Provider Demographics
NPI:1205232923
Name:NAHUEL IMAGE CENTER
Entity type:Organization
Organization Name:NAHUEL IMAGE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:REGINATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-250-6170
Mailing Address - Street 1:1700 N STATE ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1011
Mailing Address - Country:US
Mailing Address - Phone:801-822-5644
Mailing Address - Fax:888-258-9831
Practice Address - Street 1:1700 N STATE ST
Practice Address - Street 2:SUITE 16
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1011
Practice Address - Country:US
Practice Address - Phone:801-822-5644
Practice Address - Fax:888-258-9831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center