Provider Demographics
NPI:1356861108
Name:PREVENTIVE CARDIOLOGY PSC
Entity type:Organization
Organization Name:PREVENTIVE CARDIOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDINSON
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMARGO ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-390-0281
Mailing Address - Street 1:PASEO LAS CUMBRES
Mailing Address - Street 2:349 AVE FELISA RINCON DE GAUTIER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6676
Mailing Address - Country:US
Mailing Address - Phone:787-390-0281
Mailing Address - Fax:
Practice Address - Street 1:PASEO LAS CUMBRES
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6676
Practice Address - Country:US
Practice Address - Phone:787-362-1111
Practice Address - Fax:800-521-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13995207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty