1023008463 NPI number — CARDIO HEALTH CSP

Table of content: (NPI 1023008463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023008463 NPI number — CARDIO HEALTH CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIO HEALTH CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023008463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 79709
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00984-9709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-726-7438
Provider Business Mailing Address Fax Number:
787-726-2827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3018 AVE ISLA VERDE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-726-7438
Provider Business Practice Location Address Fax Number:
787-726-2827
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FIGUEROA-TORRES
Authorized Official First Name:
ENRIQUE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CARDIOLOGIST PRESIDENT
Authorized Official Telephone Number:
787-726-7438

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  12543 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1082 . This is a "PREFERRED MEDICAL CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 32475 . This is a "ASOCIACION DE MAESTROS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 600080 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9130005 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 85014 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: P528 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4057 . This is a "FIRST PLUS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 411 . This is a "AMERICAN HEALTH MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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