1174374326 NPI number — ADVANCED INTERVENTIONAL CARDIOLOGY OF PR LLC

Table of content: (NPI 1174374326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174374326 NPI number — ADVANCED INTERVENTIONAL CARDIOLOGY OF PR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED INTERVENTIONAL CARDIOLOGY OF PR LLC
Provider Last Name:
Provider First Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1174374326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 JUAN B RODRIGUEZ
Provider Second Line Business Mailing Address:
APT 1402 TORRE 2
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:
787-923-0342
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 AVE DEGETAU
Provider Second Line Business Practice Location Address:
HIMA PLAZA 1 SUITE 510
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:
787-653-3932
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2024

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA GORDO
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-923-0342

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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