Provider Demographics
NPI:1174690366
Name:CENTRO DE MEDICINA PULMONAR DR CANDELARIO
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA PULMONAR DR CANDELARIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANDELARIO LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-703-1525
Mailing Address - Street 1:PARQUE DE BUCARE
Mailing Address - Street 2:C4 BROMELIA ST.
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-744-6626
Mailing Address - Fax:787-703-1525
Practice Address - Street 1:HIMA PLAZA I
Practice Address - Street 2:500 AVE. DEGETAU SUITE 503-504
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-703-1525
Practice Address - Fax:787-703-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9002207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D38350Medicare UPIN
80433Medicare ID - Type Unspecified