Healthcare Provider Details

I. General information

NPI: 1487348520
Provider Name (Legal Business Name): INTERVENTIONAL CARDIOLOGY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 09/11/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CALLE COMERCIO
JUANA DIAZ PR
00795-1647
US

IV. Provider business mailing address

909 AVE TITO CASTRO STE 712 TORRE MEDICA SAN LUCA
PONCE PR
00716-4722
US

V. Phone/Fax

Practice location:
  • Phone: 787-260-2334
  • Fax: 787-260-1846
Mailing address:
  • Phone: 787-813-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. EDGARDO BERMUDEZ MORENO
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-260-2334