Provider Demographics
NPI:1801485727
Name:CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE
Entity type:Organization
Organization Name:CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSTITUTIONAL PROGRAMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-PADRO
Authorized Official - Suffix:
Authorized Official - Credentials:RDN,CJCP
Authorized Official - Phone:787-754-8500
Mailing Address - Street 1:PO BOX 366528
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6528
Mailing Address - Country:US
Mailing Address - Phone:787-754-8500
Mailing Address - Fax:
Practice Address - Street 1:AMERICO MIRANDA AVE MEDICAL CENTER CORNER RIO PIEDRAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-754-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-14
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR700027OtherMMM
PR40022OtherPMC
PR1378OtherIMC
PR8000282OtherHUMANA