Healthcare Provider Details

I. General information

NPI: 1962928366
Provider Name (Legal Business Name): INSTITUTO CARDIOVASCULAR DE BAYAMON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CALLE 1 EXT HERMANAS DAVILA
BAYAMON PR
00959
US

IV. Provider business mailing address

P.O. BOX 2990
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-4851
  • Fax: 787-740-3929
Mailing address:
  • Phone: 787-785-4851
  • Fax: 787-740-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. JUAN ANTONIO RODRIGUEZ
Title or Position: M.D.
Credential: MD
Phone: 787-785-4851