Healthcare Provider Details

I. General information

NPI: 1912047986
Provider Name (Legal Business Name): CARDIOVASCULAR INTERVENTIONAL THERAPEUTICS M D P S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO CARDIOVASCULAR DE PR Y DEL CARIBE SUITE NUM 9
SAN JUAN PR
00936-8344
US

IV. Provider business mailing address

PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8500
  • Fax: 787-763-2772
Mailing address:
  • Phone: 787-754-8500
  • Fax: 787-763-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LUZ O DAVILA RIVERA
Title or Position: ADMINISTRADOR
Credential:
Phone: 787-378-7827