Provider Demographics
NPI:1356535462
Name:CENTRO TECNICO CARDIOVASCULAR Y PERIFEROVASCULAR
Entity type:Organization
Organization Name:CENTRO TECNICO CARDIOVASCULAR Y PERIFEROVASCULAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED TECHNICIAN
Authorized Official - Phone:787-245-6542
Mailing Address - Street 1:SANTA BARBARA C-14
Mailing Address - Street 2:URB. SANTA MARIA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-245-6542
Mailing Address - Fax:787-815-3437
Practice Address - Street 1:CENTER FOR MEDICAL SPECIALITIES
Practice Address - Street 2:ROAD 693 KM. 5.8
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-245-6542
Practice Address - Fax:787-815-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory