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General NPI Number Information
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NPI Number | 1891045704
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Entity Type | Organization
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Legal Business Name | CARDIONOVA P.S.C.
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 2225 PONCE BYP # 2225 SUITE 908
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City | PONCE
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State | PR
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Zip | 00717-1321
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Country | US
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Telephone | 787-812-0700
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Fax | 787-812-0707
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Provider Business Mailing Address
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Address Line | PO BOX 1406
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City | JUANA DIAZ
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State | PR
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Zip | 00795-1406
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Country | US
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Telephone | 787-812-0700
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Fax | 787-812-0707
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ULISES RODRIGUEZ
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Credential | M.D.
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Telephone | 787-812-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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