Provider Demographics
NPI:1164593687
Name:CARDIONUC
Entity Type:Organization
Organization Name:CARDIONUC
Other - Org Name:CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-787-7078
Mailing Address - Street 1:PO BOX 606480
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6501
Mailing Address - Country:US
Mailing Address - Phone:787-787-7078
Mailing Address - Fax:787-798-6590
Practice Address - Street 1:CALLE SANTA CRUZ NUM 66
Practice Address - Street 2:INST SAN PABLO OFIC 202
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-7078
Practice Address - Fax:787-798-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81077Medicare PIN