Provider Demographics
NPI:1891045704
Name:CARDIONOVA P.S.C.
Entity Type:Organization
Organization Name:CARDIONOVA P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ULISES
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-0700
Mailing Address - Street 1:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1406
Mailing Address - Country:US
Mailing Address - Phone:787-812-0700
Mailing Address - Fax:787-812-0707
Practice Address - Street 1:2225 PONCE BYP # 2225
Practice Address - Street 2:SUITE 908
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-812-0700
Practice Address - Fax:787-812-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization