Basic Information
| Provider Information | |||||||||
| NPI: | 1982184941 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE CARDIOLOGY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | COND REGENCY PARK APT 305 3F | ||||||||
| Address2: | 155 CALLE CARAZO | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873547853 | ||||||||
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| Practice Location | |||||||||
| Address1: | HIMA PLAZA 1 OFIC 305 | ||||||||
| Address2: | 100 AVE LUIS MUNOZ MARIN | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879204090 | ||||||||
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| ProviderEnumerationDate: | 08/20/2018 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ PEREZ | ||||||||
| AuthorizedOfficialFirstName: | BLADIMIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENTE | ||||||||
| AuthorizedOfficialTelephone: | 7873547853 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 18640 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.