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General NPI Number Information
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NPI Number | 1376013359
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR DIAGNOSTIC CENTER LLC
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | URB. VILLA NUEVA A-20 CARR.172
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-375-5119
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4960
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City | CAGUAS
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State | PR
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Zip | 00726-4960
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Country | US
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Telephone | 787-375-5119
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FERNANDO JIMENEZ CASTRO
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Credential |
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Telephone | 787-375-5119
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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 |
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License Number State |
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