Healthcare Provider Details

I. General information

NPI: 1225017916
Provider Name (Legal Business Name): CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AMERICO MIRANDA AVE. MEDICAL CENTER CORNER
RIO PIEDRAS PR
00935-0000
US

IV. Provider business mailing address

PO BOX 366528
SAN JUAN PR
00936-6528
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8500
  • Fax: 787-999-0860
Mailing address:
  • Phone: 787-754-8500
  • Fax: 787-999-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number36
License Number StatePR

VIII. Authorized Official

Name: MR. HUMBERTO M. MONSERRATE
Title or Position: EXECUTIVE DIRECTOR
Credential: M.H.S.A.
Phone: 787-754-8500