Provider Demographics
NPI:1861838344
Name:CARDIOLOGY MEDICAL GROUP, CORP.
Entity Type:Organization
Organization Name:CARDIOLOGY MEDICAL GROUP, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGAN DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-960-1275
Mailing Address - Street 1:PO BOX 29744
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0744
Mailing Address - Country:US
Mailing Address - Phone:787-960-1275
Mailing Address - Fax:787-752-4818
Practice Address - Street 1:1820 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-3004
Practice Address - Country:US
Practice Address - Phone:787-960-1275
Practice Address - Fax:787-752-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty