Provider Demographics
NPI:1598164204
Name:PLAZA CARDIOVASCULAR CLINIC CSP
Entity Type:Organization
Organization Name:PLAZA CARDIOVASCULAR CLINIC CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODORO
Authorized Official - Middle Name:HIRAM
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-759-8157
Mailing Address - Street 1:525 DR ROOSEVELT AVE.
Mailing Address - Street 2:LA TORRE DE PLAZA SUITE 804
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-759-8157
Mailing Address - Fax:787-765-1204
Practice Address - Street 1:525 FD ROOSEVELT AVE,
Practice Address - Street 2:LA TORRE DE PLAZA SUITE 804
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-759-8157
Practice Address - Fax:787-765-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10871207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty