1225017916 NPI number — CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE

Table of content: (NPI 1558551747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225017916 NPI number — CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORPORACION CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE
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:
1225017916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 366528
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-6528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-754-8500
Provider Business Mailing Address Fax Number:
787-999-0860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AMERICO MIRANDA AVE.
Provider Second Line Business Practice Location Address:
MEDICAL CENTER CORNER
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00935-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-754-8500
Provider Business Practice Location Address Fax Number:
787-999-0860
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONSERRATE
Authorized Official First Name:
HUMBERTO
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-754-8500

Provider Taxonomy Codes

  • Taxonomy code: 284300000X , with the licence number:  36 , 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: 8000282 . This is a "HUMNA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1378 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40022 . This is a "PMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 700027 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 017895000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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