Provider Demographics
NPI:1013269810
Name:CENTRO CARDIOLOGICO PEDIATRICO SUR
Entity type:Organization
Organization Name:CENTRO CARDIOLOGICO PEDIATRICO SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-842-6467
Mailing Address - Street 1:8133 CALLE CONCORDIA
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-842-6467
Mailing Address - Fax:787-842-6467
Practice Address - Street 1:8133 CALLE CONCORDIA
Practice Address - Street 2:SUITE 103
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-842-6467
Practice Address - Fax:787-842-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR75712080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080175Medicare PIN
PROTH000Medicare UPIN