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General NPI Number Information
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NPI Number | 1174958821
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Entity Type | Organization
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Legal Business Name | CARDIO LAB SERVICES PSC
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | SANTA MARIA MEDICAL BUILDING SUITE 302 - 450 FERROCARRIL
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City | PONCE
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State | PR
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Zip | 00717-1105
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Country | US
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Telephone | 787-844-6669
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Fax | 787-844-6888
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Provider Business Mailing Address
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Address Line | SANTA MARIA MEDICAL BUILDING SUITE 302 450 FERROCARRIL
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City | PONCE
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State | PR
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Zip | 00717-1105
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Country | US
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Telephone | 787-844-6669
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Fax | 787-844-6888
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. OSCAR QUINTERO SERRANO
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Credential | MEDICO
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Telephone | 787-844-6669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10601
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License Number State | PR
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