Healthcare Provider Details

I. General information

NPI: 1386351112
Provider Name (Legal Business Name): PONCE CARDIOLOGY GROUP, P. S. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO STE 623
PONCE PR
00716-4722
US

IV. Provider business mailing address

909 AVE TITO CASTRO STE 623
PONCE PR
00716-4722
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-0909
  • Fax: 787-812-0920
Mailing address:
  • Phone: 787-812-0909
  • Fax: 787-812-0920

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: GRISELLE HERNANDEZ
Title or Position: OFFICE MANAGER
Credential: MHSA, JD, CHC
Phone: 939-628-7884