Provider Demographics
NPI:1659484061
Name:LABORATORIO CARDIOVASCULAR J.P.,CSP
Entity Type:Organization
Organization Name:LABORATORIO CARDIOVASCULAR J.P.,CSP
Other - Org Name:LABORATORIO CARDIOVASCULAR J.P.,CSP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-783-6620
Mailing Address - Street 1:PO BOX 10666
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0666
Mailing Address - Country:US
Mailing Address - Phone:787-783-6620
Mailing Address - Fax:787-793-8444
Practice Address - Street 1:STREET 21 NUM. 21 LAS LOMAS
Practice Address - Street 2:HOSPITAL METROPOLITANO 1FLOOR SUITE 103
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-783-6620
Practice Address - Fax:787-793-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8250207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3693OtherINTERNATIONAL MEDICAL CAR
PR069993OtherBLUE CROSS
PR83349OtherBLUE SHIELD
PR600084OtherMEDICARE Y MUCHO MAS
PR069993OtherBLUE CROSS
PRF93420Medicare UPIN