Provider Demographics
NPI:1760446207
Name:CENTRO CARDIOVASCULAR DE SAN GERMAN,CSP
Entity Type:Organization
Organization Name:CENTRO CARDIOVASCULAR DE SAN GERMAN,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARIBAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-264-3100
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0088
Mailing Address - Country:US
Mailing Address - Phone:787-264-3000
Mailing Address - Fax:787-892-5994
Practice Address - Street 1:EDIFICIO PLAZA METROPOLITANA
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-264-3000
Practice Address - Fax:787-892-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8633207RC0000X
PR10754207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
310754OtherCIGNA
060510OtherCRUZ AZUL
SE3332OtherPALIC
0601721OtherACAA
1603AOtherPREFERRED MEDICARE CHOICE
=========OtherOPTION HEALTH CARE
SE3332OtherPALIC
310754OtherCIGNA
=========OtherAARP
=========OtherCHAMPUS
143=========OtherGLOBAL HEALTH PLAN
=========OtherAETNA
=========OtherMAPFRE
=========OtherMED PLUS
=========OtherBLUE CROSS
=========OtherCOSUI MED
=========OtherGHI
060510OtherCRUZ AZUL
1603AOtherPREFERRED MEDICARE CHOICE
=========OtherCHAMPUS