Provider Demographics
NPI:1881106227
Name:CARDIOLOGIA PREVENTIVA CSP
Entity type:Organization
Organization Name:CARDIOLOGIA PREVENTIVA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-745-2666
Mailing Address - Street 1:QUADRANGLE MEDICAL CENTER
Mailing Address - Street 2:50 AVE L MUNOZ MARIN SUITE 303
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3982
Mailing Address - Country:US
Mailing Address - Phone:787-745-2666
Mailing Address - Fax:
Practice Address - Street 1:QUADRANGLE MEDICAL CENTER
Practice Address - Street 2:50 AVE L MUNOZ MARIN SUITE 303
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3982
Practice Address - Country:US
Practice Address - Phone:787-745-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8897207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8897OtherLICENSE