Healthcare Provider Details

I. General information

NPI: 1518234400
Provider Name (Legal Business Name): EDGE MEDICAL RESEARCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE TOMAS DAVILA #1
BARCELONETA PR
00617-2736
US

IV. Provider business mailing address

PASEO LOS CORALES II 728 MAR DE BENGAL
DORADO PR
00646-4538
US

V. Phone/Fax

Practice location:
  • Phone: 787-438-2225
  • Fax:
Mailing address:
  • Phone: 787-438-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15911
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. FRANCISCO E. CARDONA HERNANDEZ
Title or Position: OWNER
Credential: M.D.
Phone: 787-438-2225