Healthcare Provider Details

I. General information

NPI: 1720132046
Provider Name (Legal Business Name): CAPARRA SONOGRAPHY AND VASCULAR STUDIO CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BDA LAS FLORES
RIO GRANDE PR
00745-5002
US

IV. Provider business mailing address

390 CALLE GARDENIA LA PONDEROSA
RIO GRANDE PR
00745-2201
US

V. Phone/Fax

Practice location:
  • Phone: 787-809-4025
  • Fax: 787-809-3424
Mailing address:
  • Phone: 787-809-4025
  • Fax: 787-809-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: DR. EVELYN MATTA-FONTANET
Title or Position: PRESIDENT
Credential: MD
Phone: 787-809-4025