Provider Demographics
NPI:1629186358
Name:CARDIOVASCULAR ASSOCIATE OF PR
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATE OF PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-787-7078
Mailing Address - Street 1:PO BOX 6480
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5480
Mailing Address - Country:US
Mailing Address - Phone:787-787-7078
Mailing Address - Fax:787-798-6590
Practice Address - Street 1:CALLE SANTA CRUZ NUM 66
Practice Address - Street 2:INTS SAN PABLO OFIC 202
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-787-7078
Practice Address - Fax:787-798-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029155Medicare PIN