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General NPI Number Information
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NPI Number | 1598164204
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Entity Type | Organization
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Legal Business Name | PLAZA CARDIOVASCULAR CLINIC CSP
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 525 FD ROOSEVELT AVE, LA TORRE DE PLAZA SUITE 804
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-759-8157
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Fax | 787-765-1204
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Provider Business Mailing Address
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Address Line | 525 DR ROOSEVELT AVE. LA TORRE DE PLAZA SUITE 804
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-759-8157
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Fax | 787-765-1204
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. TEODORO HIRAM MERCADO
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Credential | M.D.
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Telephone | 787-759-8157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 10871
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License Number State | PR
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