Provider Demographics
NPI:1558727438
Name:YAUCO CARDIOLOGY GROUP LLC
Entity Type:Organization
Organization Name:YAUCO CARDIOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIBAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-264-3000
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0088
Mailing Address - Country:US
Mailing Address - Phone:787-264-3000
Mailing Address - Fax:787-892-5994
Practice Address - Street 1:100 CALLE HERNAN ALVAREZ
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4173
Practice Address - Country:US
Practice Address - Phone:787-264-3000
Practice Address - Fax:787-892-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG 42895Medicare UPIN
PRF 98952Medicare UPIN