Provider Demographics
NPI:1407989890
Name:ECO-CARDIOVASCULAR TESTING LAB
Entity Type:Organization
Organization Name:ECO-CARDIOVASCULAR TESTING LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-798-3463
Mailing Address - Street 1:PO BOX 9065054
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00906-5054
Mailing Address - Country:US
Mailing Address - Phone:787-798-3463
Mailing Address - Fax:787-798-3463
Practice Address - Street 1:E12 CALLE 2
Practice Address - Street 2:URBANIZACION SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6923
Practice Address - Country:US
Practice Address - Phone:787-798-3463
Practice Address - Fax:787-798-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6-1835OtherCRUZ AZUL
PR8-4330OtherSSS
PR8-4513Medicare ID - Type UnspecifiedMADICARE