1730195108 NPI number — CARDIOVASCULAR ANESTHESIA DE PUERTO RICO, PSC

Table of content: JENNIFER THUY HO PHUNG M.D. (NPI 1114180999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730195108 NPI number — CARDIOVASCULAR ANESTHESIA DE PUERTO RICO, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR ANESTHESIA DE PUERTO RICO, 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:
1730195108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 488 89 AVE. DE DIEGO
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00927-6370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-510-6716
Provider Business Mailing Address Fax Number:
787-267-4236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO CARDIOVASCULAR DE PUERTO RICO Y EL CARIBE
Provider Second Line Business Practice Location Address:
AVE. AMERICO MIRANDA -CENTRO MEDICO - DEPT ANESTESIA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-510-6716
Provider Business Practice Location Address Fax Number:
787-267-4236
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IRIZARRY
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-510-6716

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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