MEDICARE: CARDIONOVA,LLC

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	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician
2	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1124950092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIONOVA,LLC

Provider Business Mailing Address
First Line	:	PO BOX 140912
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00614-0912
Country	:	US
Telephone Number	:	787-239-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 CARR 696
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-5718
Country	:	US
Telephone Number	:	787-665-2222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENTA
Name	:	SUELY J ROMAN LOPEZ
Credential	:	MD
Telephone Number	:	787-239-4241

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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