Provider Demographics
NPI:1609952563
Name:CARDIOVASCULAR MEDICINE SERVICES PSC
Entity Type:Organization
Organization Name:CARDIOVASCULAR MEDICINE SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ-SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-745-2510
Mailing Address - Street 1:PO BOX 7196
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7196
Mailing Address - Country:US
Mailing Address - Phone:787-745-2510
Mailing Address - Fax:787-745-2510
Practice Address - Street 1:CONSOLIDATED MALL, SUITE D33C
Practice Address - Street 2:AVE. GAUTIER BENITEZ
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-2510
Practice Address - Fax:787-745-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11710207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41696Medicare UPIN
PR87744Medicare ID - Type Unspecified