Provider Demographics
NPI:1841292422
Name:CARDIO MUNICIPAL
Entity type:Organization
Organization Name:CARDIO MUNICIPAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF GROUP
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:MIESES
Authorized Official - Last Name:ARIZA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-756-7796
Mailing Address - Street 1:PO BOX 70344
Mailing Address - Street 2:PMB #68
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-756-7796
Mailing Address - Fax:787-756-7796
Practice Address - Street 1:SAN JUAN CITY HOSPITAL
Practice Address - Street 2:CARDIOLOGY SECTION - ROOM 330
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-756-7796
Practice Address - Fax:787-756-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTAX IDENTIFICATION NUMBER
PR=========OtherTAX IDENTIFICATION NUMBER