Healthcare Provider Details

I. General information

NPI: 1114219425
Provider Name (Legal Business Name): CENTRO DE CARDIOLOGIA INTERVENCIONAL Y PERIFEROVASCULAR DEL NORTE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO CARDIOCASCULAR DE PUERTO RICO Y DEL CARIBE 3RD FLOOR
SAN JUAN PR
00936-4903
US

IV. Provider business mailing address

PO BOX 364903
SAN JUAN PR
00936-4903
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8500
  • Fax:
Mailing address:
  • Phone: 787-361-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number13945
License Number StatePR

VIII. Authorized Official

Name: DR. EDWIN I PEREZ MARRERO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-361-1435