Healthcare Provider Details

I. General information

NPI: 1831342021
Provider Name (Legal Business Name): CARDIO NERVE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 1 URB. VILLAS DE LOIZA
CANOVANAS PR
00729
US

IV. Provider business mailing address

PO BOX 4956 PMB 2014
CAGUAS PR
00726-4956
US

V. Phone/Fax

Practice location:
  • Phone: 787-306-5849
  • Fax: 787-258-0742
Mailing address:
  • Phone: 787-306-5849
  • Fax: 787-258-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH VEGA
Title or Position: PRESIDENT
Credential:
Phone: 787-306-5849