Provider Demographics
NPI:1326056060
Name:CARDIO NERVE DIAGNOSTIC EXPRESS, INC
Entity Type:Organization
Organization Name:CARDIO NERVE DIAGNOSTIC EXPRESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORALES GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-261-5093
Mailing Address - Street 1:90 AVENUE RIO HONDO
Mailing Address - Street 2:PMB 454
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3105
Mailing Address - Country:US
Mailing Address - Phone:787-261-5093
Mailing Address - Fax:787-784-9264
Practice Address - Street 1:AVENUE DOS PALMAS
Practice Address - Street 2:2826 LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-0000
Practice Address - Country:US
Practice Address - Phone:787-261-5093
Practice Address - Fax:787-784-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
PR0090318261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0090318Medicare ID - Type Unspecified