Provider Demographics
NPI:1023032661
Name:CENTRO CARDIOVASCULAR DE CAROLINA
Entity Type:Organization
Organization Name:CENTRO CARDIOVASCULAR DE CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-757-0825
Mailing Address - Street 1:PO BOX 195237
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5237
Mailing Address - Country:US
Mailing Address - Phone:787-757-0825
Mailing Address - Fax:787-762-2730
Practice Address - Street 1:4AS3 VIA LETICIA
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-4801
Practice Address - Country:US
Practice Address - Phone:787-757-0825
Practice Address - Fax:787-762-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083861Medicare PIN
PR0083861AMedicare PIN
PR0083861BMedicare PIN