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NPI Code Detail

MEDICARE: CARDIOLOGY MEDICAL GROUP, CORP.

MEDICARE: CARDIOLOGY MEDICAL GROUP, CORP.
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
1174400000XSpecialist

General Provider Information

NPI Number : 1861838344
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARDIOLOGY MEDICAL GROUP, CORP.
Provider Business Mailing Address
First Line : PO BOX 29744
Second Line :
City : SAN JUAN
State : PR
Zip : 00929-0744
Country : US
Telephone Number : 787-960-1275
Fax Number : 787-752-4818
Provider Business Practice Location Address
First Line : 1820 AVE FERNANDEZ JUNCOS
Second Line :
City : SAN JUAN
State : PR
Zip : 00909-3004
Country : US
Telephone Number : 787-960-1275
Fax Number : 787-752-4818
Authorized Official
Title or Position : ADMINISTRADORA
Name : MRS. CARMEN J PAGAN DOMINGUEZ
Credential :
Telephone Number : 787-960-1275
Provider Enumeration Date : 05/10/2013
Last Update Date : 05/10/2013

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