Provider Demographics
NPI:1023163672
Name:ADVANCE CARDIOVASCULAR STUDIES, PSC
Entity type:Organization
Organization Name:ADVANCE CARDIOVASCULAR STUDIES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:MAIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-221-8161
Mailing Address - Street 1:PO BOX 20 000
Mailing Address - Street 2:PMB 23
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0000
Mailing Address - Country:US
Mailing Address - Phone:787-221-8161
Mailing Address - Fax:787-752-4128
Practice Address - Street 1:Z978 CALLE BAHUINIA LOCAL C
Practice Address - Street 2:LOIZA VALLEY
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-221-8161
Practice Address - Fax:787-752-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0057467293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057467Medicare PIN