Healthcare Provider Details

I. General information

NPI: 1316169972
Provider Name (Legal Business Name): IFG THORACIC & CARDIOVASCULAR SERVICES C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO CARDIOVASCULAR DE PR Y DEL CARIBE PISO 1 SUITE 2
RIO PIEDRAS PR
00936
US

IV. Provider business mailing address

PO BOX 70344 PMB 476
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-0451
  • Fax: 787-281-0450
Mailing address:
  • Phone: 787-281-0451
  • Fax: 787-281-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number9454
License Number StatePR

VIII. Authorized Official

Name: DR. IVAN FRANCISCO GONZALEZ-CANCEL
Title or Position: PRESIDENT
Credential: MD
Phone: 787-281-0451