Provider Demographics
NPI:1306916200
Name:CARDIOVASCULAR PROPHYLAXIS AND EVOLUTION
Entity type:Organization
Organization Name:CARDIOVASCULAR PROPHYLAXIS AND EVOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-757-7826
Mailing Address - Street 1:238 PMB BOX 70158
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8158
Mailing Address - Country:US
Mailing Address - Phone:787-757-7826
Mailing Address - Fax:
Practice Address - Street 1:GQ-13 AVE. CAMPO RICO LOCAL C-2
Practice Address - Street 2:EXT. COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-757-7826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3898293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084796Medicare ID - Type UnspecifiedIDTF