Healthcare Provider Details

I. General information

NPI: 1801485727
Provider Name (Legal Business Name): CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AMERICO MIRANDA AVE MEDICAL CENTER CORNER RIO PIEDRAS
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

PO BOX 366528
SAN JUAN PR
00936-6528
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WANDA RIVERA-PADRO
Title or Position: INSTITUTIONAL PROGRAMS DIRECTOR
Credential: RDN,CJCP
Phone: 787-754-8500