Provider Demographics
NPI:1225017916
Name:CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE
Entity Type:Organization
Organization Name:CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONSERRATE
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-754-8500
Mailing Address - Street 1:PO BOX 366528
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6528
Mailing Address - Country:US
Mailing Address - Phone:787-754-8500
Mailing Address - Fax:787-999-0860
Practice Address - Street 1:AMERICO MIRANDA AVE.
Practice Address - Street 2:MEDICAL CENTER CORNER
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935-0000
Practice Address - Country:US
Practice Address - Phone:787-754-8500
Practice Address - Fax:787-999-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8000282OtherHUMNA
PR1378OtherIMC
PR40022OtherPMC
PR700027OtherMMM
PR1378OtherIMC
PR400124Medicare Oscar/Certification