Healthcare Provider Details

I. General information

NPI: 1407197502
Provider Name (Legal Business Name): CPR CARDIO CARE, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DE DIEGO CPR BUILDING SUITE 303-304
MAYAGUEZ PR
00681
US

IV. Provider business mailing address

PO BOX 1522
MAYAGUEZ PR
00681-1522
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-6100
  • Fax: 787-833-5980
Mailing address:
  • Phone: 787-833-6100
  • Fax: 787-833-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number7697
License Number StatePR

VIII. Authorized Official

Name: MISS JESSICA RODRIGUEZ MALDONADO
Title or Position: ASSISTANT
Credential: BS
Phone: 787-310-9812