Provider Demographics
NPI:1871653543
Name:CARDIVASCULAR AMB CLINIC
Entity Type:Organization
Organization Name:CARDIVASCULAR AMB CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:SANCHEZ
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1787-738-7595
Mailing Address - Street 1:PERLA DEL CARIBE 205
Mailing Address - Street 2:MANSIONES MONTE VERDE
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4158
Mailing Address - Country:US
Mailing Address - Phone:787-738-7595
Mailing Address - Fax:
Practice Address - Street 1:AVE. ANTONIO R. BARCELO # 5
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-7595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081560Medicare PIN