Provider Demographics
NPI:1902608037
Name:PUENTES, SAMUEL (RT (ARRT))
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:PUENTES
Suffix:
Gender:
Credentials:RT (ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3818
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-3818
Mailing Address - Country:US
Mailing Address - Phone:928-285-7857
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3818
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-3818
Practice Address - Country:US
Practice Address - Phone:928-285-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRT-71133335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier