Provider Demographics
NPI:1104903970
Name:CARDIOMED ONE PSC
Entity type:Organization
Organization Name:CARDIOMED ONE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEFTALI
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-766-2200
Mailing Address - Street 1:FELISA RINCON DE GAUTIER
Mailing Address - Street 2:COND PASEO MONTE 1608
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6662
Mailing Address - Country:US
Mailing Address - Phone:787-766-2200
Mailing Address - Fax:787-766-8548
Practice Address - Street 1:1716 CALLE PARANA
Practice Address - Street 2:EL CEREZAL
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-3148
Practice Address - Country:US
Practice Address - Phone:787-766-2200
Practice Address - Fax:787-766-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty