=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730179797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOHEALTH PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | LAUREL ST 2413
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-726-7438
-----------------------------------------------------
Fax | 787-726-2827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB 427 LOLZA ST 2434
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-726-7438
-----------------------------------------------------
Fax | 787-726-2827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. AMARANZA MARIE GRILLASCA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-726-7438
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 12543
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 12543
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------