Healthcare Provider Details

I. General information

NPI: 1265272892
Provider Name (Legal Business Name): CARDIOVASCULAR RADIOLOGY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE SAN CRISTOBAL OFICINA #108 COTO LAUREL
PONCE PR
00780
US

IV. Provider business mailing address

P.O. BOX 9101
SAN JUAN PR
00908-9101
US

V. Phone/Fax

Practice location:
  • Phone: 787-268-1015
  • Fax: 787-268-5511
Mailing address:
  • Phone: 787-268-1015
  • Fax: 787-268-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. GERARDO MARQUEZ SR.
Title or Position: PRESIDENTE
Credential:
Phone: 787-268-1015