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General NPI Number Information
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NPI Number | 1982184941
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CARDIOLOGY CENTER LLC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | HIMA PLAZA 1 OFIC 305 100 AVE LUIS MUNOZ MARIN
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-920-4090
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Fax |
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Provider Business Mailing Address
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Address Line | COND REGENCY PARK APT 305 3F 155 CALLE CARAZO
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City | GUAYNABO
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State | PR
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Zip | 00971
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Country | US
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Telephone | 787-354-7853
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | BLADIMIR SANCHEZ PEREZ
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Credential | MD
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Telephone | 787-354-7853
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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 | 18640
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License Number State | PR
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