Provider Demographics
NPI:1164691705
Name:BOULEVARD CARDIOVASCULAR DIAGNOSTIC INC
Entity Type:Organization
Organization Name:BOULEVARD CARDIOVASCULAR DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTORELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-795-8855
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-1203
Mailing Address - Country:US
Mailing Address - Phone:787-795-8855
Mailing Address - Fax:888-612-9595
Practice Address - Street 1:LAS PALMAS VILLAGE CALLE 19 ESQUINA A
Practice Address - Street 2:LOCAL 3
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-0000
Practice Address - Country:US
Practice Address - Phone:787-795-8855
Practice Address - Fax:888-612-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBR469AMedicare PIN