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General NPI Number Information
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NPI Number | 1477657179
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Entity Type | Organization
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Legal Business Name | CAMPO RICO CARDIOVASCULAR CENTER
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | AVENIDA CAMPO RICO GO9 COUNTRY CLUB
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City | CAROLINA
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State | PR
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Zip | 00982
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Country | US
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Telephone | 787-757-3111
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Fax |
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Provider Business Mailing Address
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Address Line | BB25 CALLE 104
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City | CAROLINA
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State | PR
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Zip | 00983-2004
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Country | US
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Telephone | 787-757-3111
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CARLOS RUBEN GONZALEZ
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Credential | M.D.
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Telephone | 787-757-3111
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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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