Provider Demographics
NPI:1851361760
Name:ASOCIACION CARDIOVASCULAR DEL SUR DE PUERTO RICO, INC.
Entity Type:Organization
Organization Name:ASOCIACION CARDIOVASCULAR DEL SUR DE PUERTO RICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:VERA MIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-844-2049
Mailing Address - Street 1:108 TORRE SAN CRISTOBAL
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2844
Mailing Address - Country:US
Mailing Address - Phone:787-844-2049
Mailing Address - Fax:787-843-0045
Practice Address - Street 1:108 TORRE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2844
Practice Address - Country:US
Practice Address - Phone:787-844-2049
Practice Address - Fax:787-843-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9213207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
81042Medicare ID - Type Unspecified