Provider Demographics
NPI:1417463126
Name:CARIBBEAN CARDIAC & THORACIC SURGERY INSTITUTE, LLC
Entity Type:Organization
Organization Name:CARIBBEAN CARDIAC & THORACIC SURGERY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MULERO PORTELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-843-5360
Mailing Address - Street 1:PO BOX 10249
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0249
Mailing Address - Country:US
Mailing Address - Phone:787-843-5360
Mailing Address - Fax:787-812-0417
Practice Address - Street 1:917 AVE. TITO CASTRO, TORRE MEDICA SAN LUCAS
Practice Address - Street 2:SUITE 519
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-843-5360
Practice Address - Fax:787-812-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10847208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1669464517Medicaid