Healthcare Provider Details

I. General information

NPI: 1639269301
Provider Name (Legal Business Name): DR.EDGARDO BERMUDEZ,SERVICIOS CARDIOVASCULARES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAINT LUKE MEMORIAL HOSPITAL 909 AVE. TITO CASTRO TORRE MEDICA SUITE 712
PONCE PR
00716
US

IV. Provider business mailing address

P O BOX 7334
PONCE PR
00732-7334
US

V. Phone/Fax

Practice location:
  • Phone: 787-813-0550
  • Fax: 787-813-0566
Mailing address:
  • Phone: 787-813-0550
  • Fax: 787-813-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number10593
License Number StatePR

VIII. Authorized Official

Name: DR. EDGARDO BERMUDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-813-0550