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General NPI Number Information
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NPI Number | 1659536597
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Entity Type | Organization
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Legal Business Name | CARDIAC AND VASCULAR IMAGING AND MEDICAL GROUP PSC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1501 AVE FERNANDEZ JUNCOS SUITE 101
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City | SAN JUAN
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State | PR
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Zip | 00909-2760
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Country | US
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Telephone | 787-268-6793
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8135
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City | SAN JUAN
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State | PR
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Zip | 00910-0135
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Country | US
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Telephone | 787-268-6836
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. OSCAR CRESPO
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Credential | MD.
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Telephone | 787-529-8163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 011391
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License Number State | PR
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