Healthcare Provider Details

I. General information

NPI: 1801007794
Provider Name (Legal Business Name): CARDIOVASCULAR MEDICAL DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. BERWIND ESTATES CALLE 17 T-9
SAN JUAN PR
00924
US

IV. Provider business mailing address

URB. BERWIND ESTATES CALLE 17 T-9
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-4818
  • Fax: 787-752-4818
Mailing address:
  • Phone: 787-752-4818
  • Fax: 787-752-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number3878
License Number StatePR

VIII. Authorized Official

Name: MRS. CARMEN JUDITH PAGAN
Title or Position: PRESIDENTA
Credential:
Phone: 787-960-1275