Healthcare Provider Details

I. General information

NPI: 1437409976
Provider Name (Legal Business Name): GRUPO MEDICO CARDIOVASCULAR-PY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GK29 AVE ROBERTO SANCHEZ VILELLA
CAROLINA PR
00982-2657
US

IV. Provider business mailing address

URB. EL COMANDANTE C/ ANTONIO LUCIANO 1238
SAN JUAN PUERTO RICO
00924
UM

V. Phone/Fax

Practice location:
  • Phone: 787-565-8179
  • Fax:
Mailing address:
  • Phone: 787-565-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. YANISLEY CRESPO LAHERA
Title or Position: OWNER
Credential:
Phone: 787-565-8179