Provider Demographics
NPI:1326465311
Name:MD CARDIOVASCULAR PSC
Entity Type:Organization
Organization Name:MD CARDIOVASCULAR PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVARIE DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-746-7990
Mailing Address - Street 1:PO BOX 1630
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1630
Mailing Address - Country:US
Mailing Address - Phone:787-746-7990
Mailing Address - Fax:787-743-1340
Practice Address - Street 1:1396 CALLE SAN RAFAEL
Practice Address - Street 2:MEDICAL PAVILLION STE 16 17
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2526
Practice Address - Country:US
Practice Address - Phone:787-722-2992
Practice Address - Fax:787-998-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5544305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0026738Medicare PIN