Healthcare Provider Details

I. General information

NPI: 1093846164
Provider Name (Legal Business Name): GINEBRA CARDIOVASCULAR DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO RINCO CARR 171 KM 4 HM4 SEC NOGUERAS
CIDRA PR
00739
US

IV. Provider business mailing address

M19 CALLE RUBI URB. LA PLATA
CAYEY PR
00736-4873
US

V. Phone/Fax

Practice location:
  • Phone: 787-383-9005
  • Fax: 787-714-2308
Mailing address:
  • Phone: 787-383-9005
  • Fax: 787-714-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN MANUEL GINEBRA VAZQUEZ
Title or Position: PRESIDENTE
Credential:
Phone: 787-383-9005