Healthcare Provider Details

I. General information

NPI: 1861838344
Provider Name (Legal Business Name): CARDIOLOGY MEDICAL GROUP, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 AVE FERNANDEZ JUNCOS
SAN JUAN PR
00909-3004
US

IV. Provider business mailing address

PO BOX 29744
SAN JUAN PR
00929-0744
US

V. Phone/Fax

Practice location:
  • Phone: 787-960-1275
  • Fax: 787-752-4818
Mailing address:
  • Phone: 787-960-1275
  • Fax: 787-752-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMEN J PAGAN DOMINGUEZ
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-960-1275