Provider Demographics
NPI:1316235468
Name:CSP CARDIOMAX CORP
Entity type:Organization
Organization Name:CSP CARDIOMAX CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-530-3206
Mailing Address - Street 1:PO BOX 367715
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5715
Mailing Address - Country:US
Mailing Address - Phone:787-536-3200
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO UNION PLAZA PISO 8
Practice Address - Street 2:OFICINA 802
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory