Provider Demographics
NPI:1285687780
Name:CENTRO CARDIOVASCULAR DE MANATI III CSP
Entity Type:Organization
Organization Name:CENTRO CARDIOVASCULAR DE MANATI III CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINEZ BARROSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-6361
Mailing Address - Street 1:1 CALLE MARGINAL EXT
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4998
Mailing Address - Country:US
Mailing Address - Phone:787-854-6361
Mailing Address - Fax:787-884-3021
Practice Address - Street 1:1 CALLE MARGINAL EXT
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4998
Practice Address - Country:US
Practice Address - Phone:787-854-6361
Practice Address - Fax:787-884-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82096Medicare PIN