=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619336245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCE CARDIOVASCULAR SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2016
-----------------------------------------------------
Last Update Date | 02/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2225 PONCE BY PASS EDIFICIO PARRA SUITE 908
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-812-0700
-----------------------------------------------------
Fax | 787-812-0700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1406
-----------------------------------------------------
City | JUANA DIAZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00795-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-812-0700
-----------------------------------------------------
Fax | 787-812-0707
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ULISES RODRIGUEZ RAMOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-812-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------