Provider Demographics
NPI:1912189366
Name:CENTRO CARDIOVASCULAR DEL ESTE, C.S.P.
Entity Type:Organization
Organization Name:CENTRO CARDIOVASCULAR DEL ESTE, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-860-0075
Mailing Address - Street 1:PMB 202
Mailing Address - Street 2:P.O. BOX 70005
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-0075
Mailing Address - Fax:787-863-6246
Practice Address - Street 1:375 AVE GEN VALERO
Practice Address - Street 2:SUITE 105
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4893
Practice Address - Country:US
Practice Address - Phone:787-860-0075
Practice Address - Fax:787-863-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty