Provider Demographics
NPI:1043477995
Name:CENTRO CARDIOVASCULAR DE CAROLINA I
Entity Type:Organization
Organization Name:CENTRO CARDIOVASCULAR DE CAROLINA I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRED SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-757-0825
Mailing Address - Street 1:PO BOX 2250
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2239
Mailing Address - Country:US
Mailing Address - Phone:787-757-0620
Mailing Address - Fax:787-762-2730
Practice Address - Street 1:4A S3 ANEXO PISO 2 FRAGOSO AVE
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
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:2008-05-19
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center