Provider Demographics
NPI:1750074589
Name:INNOVATIVE CARDIOLOGY
Entity type:Organization
Organization Name:INNOVATIVE CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:LOPEZ MAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-492-2000
Mailing Address - Street 1:PO BOX 7772
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7772
Mailing Address - Country:US
Mailing Address - Phone:787-492-2000
Mailing Address - Fax:
Practice Address - Street 1:2225 PONCE BYP STE 603-604
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-492-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty