Provider Demographics
NPI:1376860049
Name:PONCE CARDIO IMAGING, PSC
Entity Type:Organization
Organization Name:PONCE CARDIO IMAGING, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-258-8600
Mailing Address - Street 1:1357 ASHFORD AVE.
Mailing Address - Street 2:PMB 409
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-653-0505
Mailing Address - Fax:787-258-8600
Practice Address - Street 1:1357 ASHFORD AVE.
Practice Address - Street 2:PMB 409
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-653-0505
Practice Address - Fax:787-258-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty