Provider Demographics
NPI:1275208704
Name:INTEGRATED CARDIOVASCULAR SOLUTIONS LLC
Entity Type:Organization
Organization Name:INTEGRATED CARDIOVASCULAR SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLESTER MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-680-7318
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 129 KM 1.0 AVE SAN LUIS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-680-7318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty