Provider Demographics
NPI:1982184941
Name:INNOVATIVE CARDIOLOGY CENTER LLC
Entity Type:Organization
Organization Name:INNOVATIVE CARDIOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:BLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-354-7853
Mailing Address - Street 1:COND REGENCY PARK APT 305 3F
Mailing Address - Street 2:155 CALLE CARAZO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-354-7853
Mailing Address - Fax:
Practice Address - Street 1:HIMA PLAZA 1 OFIC 305
Practice Address - Street 2:100 AVE LUIS MUNOZ MARIN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-920-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18640207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty