Basic Information
| Provider Information | |||||||||
| NPI: | 1891045704 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDIONOVA P.S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1406 | ||||||||
| Address2: | |||||||||
| City: | JUANA DIAZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007951406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878120700 | ||||||||
| FaxNumber: | 7878120707 | ||||||||
| Practice Location | |||||||||
| Address1: | 2225 PONCE BYP # 2225 | ||||||||
| Address2: | SUITE 908 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878120700 | ||||||||
| FaxNumber: | 7878120707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | ULISES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878120700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.