Healthcare Provider Details

I. General information

NPI: 1750074589
Provider Name (Legal Business Name): INNOVATIVE CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BYP STE 603-604
PONCE PR
00717-1321
US

IV. Provider business mailing address

PO BOX 7772
PONCE PR
00732-7772
US

V. Phone/Fax

Practice location:
  • Phone: 787-492-2000
  • Fax:
Mailing address:
  • Phone: 787-492-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEJANDRO JOSE LOPEZ MAS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-492-2000