Provider Demographics
NPI:1699021816
Name:MODERN CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MODERN CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT-CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-505-3750
Mailing Address - Street 1:675 CALLE S CUEVAS BUSTAMANTE
Mailing Address - Street 2:BOX 29
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 AVE PONCE DE LEON # 431
Practice Address - Street 2:NATIONAL PLAZA BUILDING SUITE 326
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1000
Practice Address - Country:US
Practice Address - Phone:787-413-7998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty