Provider Demographics
NPI:1407197502
Name:CPR CARDIO CARE, CSP
Entity Type:Organization
Organization Name:CPR CARDIO CARE, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:787-310-9812
Mailing Address - Street 1:PO BOX 1522
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1522
Mailing Address - Country:US
Mailing Address - Phone:787-833-6100
Mailing Address - Fax:787-833-5980
Practice Address - Street 1:55 DE DIEGO CPR BUILDING
Practice Address - Street 2:SUITE 303-304
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-833-6100
Practice Address - Fax:787-833-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7697207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1518925288OtherNPI
PR1518162890OtherNPI