Provider Demographics
NPI:1487377552
Name:CARDIOWEST CLINICA CARDIOVASCULAR LLC
Entity type:Organization
Organization Name:CARDIOWEST CLINICA CARDIOVASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-261-0667
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0154
Mailing Address - Country:US
Mailing Address - Phone:939-261-0667
Mailing Address - Fax:
Practice Address - Street 1:2770 AVE HOSTOS STE 309
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6386
Practice Address - Country:US
Practice Address - Phone:939-261-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR019491OtherLIC