Healthcare Provider Details

I. General information

NPI: 1568583623
Provider Name (Legal Business Name): CARDIOVASCULAR RADIOLOGY CENTRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO CARDIOVASCULAR DE PR Y DEL CARIBE SUITE 1
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 11792
SAN JUAN PR
00910-2892
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-1765
  • Fax: 787-771-9182
Mailing address:
  • Phone: 787-268-1015
  • Fax: 787-268-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number5340
License Number StatePR

VIII. Authorized Official

Name: FRANK A GAUDIER GUERRA JR.
Title or Position: OWNER
Credential: MD
Phone: 787-727-0500