Basic Information
| Provider Information | |||||||||
| NPI: | 1578757043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRO CARDIOVASCULAR DE LA MONTANA,CSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 AVE TITO CASTRO | ||||||||
| Address2: | SUITE 102 PMB 261 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878295112 | ||||||||
| FaxNumber: | 7878120565 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 CALLE MUNOZ RIVERA | ||||||||
| Address2: | |||||||||
| City: | ADJUNTAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006012202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878295112 | ||||||||
| FaxNumber: | 7878120565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | RAMOS | ||||||||
| AuthorizedOfficialFirstName: | RIGOBERTO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878295112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 9656 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.