MEDICARE: ADVANCE CARDIOVASCULAR STUDIES, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory	0057467	PR

General Provider Information

NPI Number	:	1023163672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE CARDIOVASCULAR STUDIES, PSC

Provider Business Mailing Address
First Line	:	PO BOX 20 000
Second Line	:	PMB 23
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0000
Country	:	US
Telephone Number	:	787-221-8161
Fax Number	:	787-752-4128

Provider Business Practice Location Address
First Line	:	Z978 CALLE BAHUINIA LOCAL C
Second Line	:	LOIZA VALLEY
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0000
Country	:	US
Telephone Number	:	787-221-8161
Fax Number	:	787-752-4128

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	MR. MAIKEL GARCIA FERNANDEZ
Credential	:
Telephone Number	:	787-221-8161

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	03/01/2016

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