MEDICARE: CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	284300000X	Special Hospital	36	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8000282	OTHER	PR	HUMNA
2	1378	OTHER	PR	IMC
3	40022	OTHER	PR	PMC
4	700027	OTHER	PR	MMM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225017916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE

Provider Business Mailing Address
First Line	:	PO BOX 366528
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-6528
Country	:	US
Telephone Number	:	787-754-8500
Fax Number	:	787-999-0860

Provider Business Practice Location Address
First Line	:	AMERICO MIRANDA AVE.
Second Line	:	MEDICAL CENTER CORNER
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00935-0000
Country	:	US
Telephone Number	:	787-754-8500
Fax Number	:	787-999-0860

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. HUMBERTO M. MONSERRATE
Credential	:	M.H.S.A.
Telephone Number	:	787-754-8500

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	02/15/2021

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