Provider Demographics
NPI:1265545107
Name:CENTRO CIRUGIA CARDIOVASCULAR DAMAS
Entity type:Organization
Organization Name:CENTRO CIRUGIA CARDIOVASCULAR DAMAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO & ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VICENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-840-8686
Mailing Address - Street 1:286 CALLE MONTERREY
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1377
Mailing Address - Country:US
Mailing Address - Phone:787-840-8686
Mailing Address - Fax:787-840-0086
Practice Address - Street 1:2213 PONCE BYP
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1318
Practice Address - Country:US
Practice Address - Phone:787-840-8686
Practice Address - Fax:787-840-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085073Medicare ID - Type Unspecified