Provider Demographics
NPI:1104895002
Name:INSTITUTO CARDIOVASCULAR SAN RAFAEL
Entity type:Organization
Organization Name:INSTITUTO CARDIOVASCULAR SAN RAFAEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-722-2992
Mailing Address - Street 1:1396 CALLE SAN RAFAEL
Mailing Address - Street 2:CONDOMINIO MEDICAL PAVILION SUITE 17
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2526
Mailing Address - Country:US
Mailing Address - Phone:787-722-2992
Mailing Address - Fax:787-724-2710
Practice Address - Street 1:1396 CALLE SAN RAFAEL
Practice Address - Street 2:CONDOMINIO MEDICAL PAVILION SUITE 17
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2526
Practice Address - Country:US
Practice Address - Phone:787-722-2992
Practice Address - Fax:787-724-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5544207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-1012Medicare ID - Type Unspecified