Healthcare Provider Details

I. General information

NPI: 1013269810
Provider Name (Legal Business Name): CENTRO CARDIOLOGICO PEDIATRICO SUR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8133 CALLE CONCORDIA SUITE 103
PONCE PR
00717
US

IV. Provider business mailing address

8133 CALLE CONCORDIA SUITE 103
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-6467
  • Fax: 787-842-6467
Mailing address:
  • Phone: 787-842-6467
  • Fax: 787-842-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number7571
License Number StatePR

VIII. Authorized Official

Name: MRS. ANA D. FINCH
Title or Position: PRESIDENT
Credential: MD
Phone: 787-842-6467