Provider Demographics
NPI:1659536597
Name:CARDIAC AND VASCULAR IMAGING AND MEDICAL GROUP PSC
Entity Type:Organization
Organization Name:CARDIAC AND VASCULAR IMAGING AND MEDICAL GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-529-8163
Mailing Address - Street 1:PO BOX 8135
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0135
Mailing Address - Country:US
Mailing Address - Phone:787-268-6836
Mailing Address - Fax:
Practice Address - Street 1:1501 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2760
Practice Address - Country:US
Practice Address - Phone:787-268-6793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011391261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology