Healthcare Provider Details

I. General information

NPI: 1376851873
Provider Name (Legal Business Name): CARDIAC RHYTHM CONSULTANTS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAN BULEVAR PASEOS CARDIAC RHYTHM CONSULTANTS SUITE 102 CPG GALERIA PASEOS
SAN JUAN PR
00926
US

IV. Provider business mailing address

COND MONTE MAYOR # 652 JUAN C DE BORBON 44
GUAYNABO PR
00969-4001
US

V. Phone/Fax

Practice location:
  • Phone: 787-771-3030
  • Fax: 888-378-0294
Mailing address:
  • Phone: 787-378-4718
  • Fax: 888-378-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16079
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number16079
License Number StatePR

VIII. Authorized Official

Name: DR. OMAR NIEVES ORTIZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-378-4718