1598164204 NPI number — PLAZA CARDIOVASCULAR CLINIC CSP

Table of content: (NPI 1598164204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598164204 NPI number — PLAZA CARDIOVASCULAR CLINIC CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAZA CARDIOVASCULAR CLINIC 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:
1598164204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 DR ROOSEVELT AVE.
Provider Second Line Business Mailing Address:
LA TORRE DE PLAZA SUITE 804
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-759-8157
Provider Business Mailing Address Fax Number:
787-765-1204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 FD ROOSEVELT AVE,
Provider Second Line Business Practice Location Address:
LA TORRE DE PLAZA SUITE 804
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-759-8157
Provider Business Practice Location Address Fax Number:
787-765-1204
Provider Enumeration Date:
08/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MERCADO
Authorized Official First Name:
TEODORO
Authorized Official Middle Name:
HIRAM
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-759-8157

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  10871 , 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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