Provider Demographics
NPI:1891866521
Name:CARDIOLOGY MEDICAL SERVICES
Entity Type:Organization
Organization Name:CARDIOLOGY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MS
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:787-727-1742
Mailing Address - Street 1:238 PMB BOX 70158
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8158
Mailing Address - Country:US
Mailing Address - Phone:787-727-1742
Mailing Address - Fax:
Practice Address - Street 1:1820 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:PARADA 26
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-3004
Practice Address - Country:US
Practice Address - Phone:787-727-1742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3898293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031416Medicare ID - Type UnspecifiedIDTF