1831526540 NPI number — CARIBBEAN HEART & VASCULAR GROUP PSC

Table of content: (NPI 1831526540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831526540 NPI number — CARIBBEAN HEART & VASCULAR GROUP PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARIBBEAN HEART & VASCULAR GROUP 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:
1831526540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-652-9200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 AVE. HOSTOS
Provider Second Line Business Practice Location Address:
PRIMER PISO-OFICINA 112N
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-652-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ACEVEDO-GONZALEZ
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-673-1123

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  16933 , 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: 327732 . This is a "CERTIFICACION DE REGISTRO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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