Provider Demographics
NPI:1700010501
Name:CENTRO DE MEDICINA CARDIOVASCULAR Y MEDICINA NUCLEAR SAN CARLOS
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA CARDIOVASCULAR Y MEDICINA NUCLEAR SAN CARLOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STOCKHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONFESOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LA SALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-439-9462
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-877-8000
Mailing Address - Fax:
Practice Address - Street 1:CONCEPCION VERA AYALA 550 HOSPITAL SAN CARLOS BORROMEO
Practice Address - Street 2:1ER PISO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty