Healthcare Provider Details

I. General information

NPI: 1881659548
Provider Name (Legal Business Name): MEDICAL CARDIOVASCULAR SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 AVE BORINQUEN
SAN JUAN PR
00915-3824
US

IV. Provider business mailing address

PO BOX 14511
SAN JUAN PR
00916-4511
US

V. Phone/Fax

Practice location:
  • Phone: 787-268-0525
  • Fax: 787-268-0525
Mailing address:
  • Phone: 787-268-0525
  • Fax: 787-268-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: CARMELO NEIRA LUGO
Title or Position: OWNER
Credential:
Phone: 787-268-0525