Provider Demographics
NPI:1467917294
Name:PR CARDIOLOGY GROUP PSC
Entity Type:Organization
Organization Name:PR CARDIOLOGY GROUP PSC
Other - Org Name:PR CARDIOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:REYES - APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-721-6380
Mailing Address - Street 1:PO BOX 23318
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-3318
Mailing Address - Country:US
Mailing Address - Phone:787-721-6380
Mailing Address - Fax:
Practice Address - Street 1:ASHFORD MEDICAL CENTER SUITE 805
Practice Address - Street 2:29 CALLE WASHINGTON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-721-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty