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General NPI Number Information
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NPI Number | 1326465311
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Entity Type | Organization
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Legal Business Name | MD CARDIOVASCULAR PSC
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 1396 CALLE SAN RAFAEL MEDICAL PAVILLION STE 16 17
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City | SAN JUAN
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State | PR
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Zip | 00909-2526
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Country | US
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Telephone | 787-722-2992
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Fax | 787-998-7010
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Provider Business Mailing Address
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Address Line | PO BOX 1630
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City | CAGUAS
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State | PR
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Zip | 00726-1630
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Country | US
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Telephone | 787-746-7990
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Fax | 787-743-1340
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Authorized Official
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Title or Position | CARDIOLOGY
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Name | DR. MARCOS DEVARIE DIAZ
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Credential |
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Telephone | 787-746-7990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 5544
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License Number State | PR
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