Provider Demographics
NPI:1417163049
Name:MYP ECHOCARDIOGRAPHY CSP
Entity Type:Organization
Organization Name:MYP ECHOCARDIOGRAPHY CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-1313
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1150
Mailing Address - Country:US
Mailing Address - Phone:787-854-1313
Mailing Address - Fax:787-884-5320
Practice Address - Street 1:MANATI MEDICAL PLAZA, SUITE 107-108, SECTOR LA LOMITA
Practice Address - Street 2:#1 CALLE JOSE CANDELAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-1150
Practice Address - Country:US
Practice Address - Phone:787-854-1313
Practice Address - Fax:787-884-5320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6738174400000X
PR7834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherMEDICARE HEALTHCARE INC.
PR31134Medicare ID - Type Unspecified