1982184941 NPI number — INNOVATIVE CARDIOLOGY CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982184941 NPI number — INNOVATIVE CARDIOLOGY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE CARDIOLOGY CENTER LLC
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:
1982184941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND REGENCY PARK APT 305 3F
Provider Second Line Business Mailing Address:
155 CALLE CARAZO
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-354-7853
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIMA PLAZA 1 OFIC 305
Provider Second Line Business Practice Location Address:
100 AVE LUIS MUNOZ MARIN
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-920-4090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ PEREZ
Authorized Official First Name:
BLADIMIR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-354-7853

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  18640 , 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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