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General NPI Number Information
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NPI Number | 1467779512
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Entity Type | Organization
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Legal Business Name | CARIBBEAN VASCULAR SERVICES PC
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 909 AVE TITO CASTRO TORRE MEDICA SAN LUCAS STE 602
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City | PONCE
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State | PR
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Zip | 00716-4728
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Country | US
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Telephone | 787-651-1429
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Fax | 787-651-1430
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Provider Business Mailing Address
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Address Line | 604 CALLE FELIPE MANSION REAL
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City | COTO LAUREL
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State | PR
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Zip | 00780-2640
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Country | US
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Telephone | 787-908-7645
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE L MARTINEZ TRABAL
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Credential |
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Telephone | 787-908-7645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 14241
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License Number State | PR
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