Provider Demographics
NPI:1588634489
Name:CORAZON A CORAZON SERVICIOS MEDICOS CORP
Entity Type:Organization
Organization Name:CORAZON A CORAZON SERVICIOS MEDICOS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAIDIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-270-5185
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-1568
Mailing Address - Country:US
Mailing Address - Phone:787-270-5185
Mailing Address - Fax:787-270-5395
Practice Address - Street 1:#57 LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-5185
Practice Address - Fax:787-270-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5415940001Medicare ID - Type Unspecified