MEDICARE: LABORATORIO CARDIOVASCULAR DEL NORTE INC

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	246X00000X	Cardiovascular Specialist/Technologist	4954	PR

General Provider Information

NPI Number	:	1285735407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CARDIOVASCULAR DEL NORTE INC

Provider Business Mailing Address
First Line	:	PO BOX 12003
Second Line	:	CAPARRA HEIGHTS STA
City	:	SAN JUAN
State	:	PR
Zip	:	00922-2003
Country	:	US
Telephone Number	:	787-854-3826
Fax Number	:	787-884-5334

Provider Business Practice Location Address
First Line	:	LAB. CARDIOVASCULAR DEL NORTE-HOSPITAL DOCTORS CENTER
Second Line	:	SUITE 301, THIRD FLOOR, #2 STREET
City	:	MANATI
State	:	PR
Zip	:	00674-0000
Country	:	US
Telephone Number	:	787-854-3826
Fax Number	:	787-884-5334

Authorized Official
Title or Position	:	ADMINISTRADORA
Name	:	MRS. GLORIA M CACERES
Credential	:
Telephone Number	:	787-854-3826

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/28/2017

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