Healthcare Provider Details

I. General information

NPI: 1316816010
Provider Name (Legal Business Name): CARDIOCARE & VASCULAR GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 AVE PONCE DE LEON EDIF CENTRO EUROPA SUITE 502
SAN JUAN PR
00907-4024
US

IV. Provider business mailing address

PO BOX 11577 FERNANDEZ JUNCOS STATION
SAN JUAN PR
00910-2677
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-5017
  • Fax: 787-723-5015
Mailing address:
  • Phone: 787-723-5017
  • Fax: 787-723-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE A RODRIGUEZ ESCUDERO
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 787-723-5017