Provider Demographics
NPI:1174958821
Name:CARDIO LAB SERVICES PSC
Entity type:Organization
Organization Name:CARDIO LAB SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:QUINTERO
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICO
Authorized Official - Phone:787-844-6669
Mailing Address - Street 1:SANTA MARIA MEDICAL BUILDING
Mailing Address - Street 2:SUITE 302 450 FERROCARRIL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1105
Mailing Address - Country:US
Mailing Address - Phone:787-844-6669
Mailing Address - Fax:787-844-6888
Practice Address - Street 1:SANTA MARIA MEDICAL BUILDING
Practice Address - Street 2:SUITE 302 - 450 FERROCARRIL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1105
Practice Address - Country:US
Practice Address - Phone:787-844-6669
Practice Address - Fax:787-844-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1194723262OtherNPI
PR1740364587OtherNPI