1467771998 NPI number — PONCE CARDIOVASCULAR SERVICES, PSC

Table of content: MARK STERNE PHYSICAL THERAPIST (NPI 1730488016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467771998 NPI number — PONCE CARDIOVASCULAR SERVICES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PONCE CARDIOVASCULAR SERVICES, PSC
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:
1467771998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 AVE TITO CASTRO
Provider Second Line Business Mailing Address:
TORRE MEDICA SAN LUCAS SUITE 522
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-4728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-259-3373
Provider Business Mailing Address Fax Number:
787-259-3373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 AVE TITO CASTRO
Provider Second Line Business Practice Location Address:
TORRE MEDICA SAN LUCAS SUITE 522
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-259-3373
Provider Business Practice Location Address Fax Number:
787-259-3373
Provider Enumeration Date:
05/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ GARCIA
Authorized Official First Name:
CESAR
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
CARDIOLOGIST, DIRECTOR
Authorized Official Telephone Number:
787-259-3373

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  16230 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 8504 , 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)





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