Provider Demographics
NPI:1871812271
Name:ADVANCED CARDIOVASCULAR IMAGING PCS
Entity type:Organization
Organization Name:ADVANCED CARDIOVASCULAR IMAGING PCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-787-7078
Mailing Address - Street 1:COND COLINA REAL APT 1101
Mailing Address - Street 2:FELIZA GAUTIER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-787-7078
Mailing Address - Fax:787-798-6590
Practice Address - Street 1:COND COLINA REAL APT 1101
Practice Address - Street 2:FELIZA GAUTIER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-787-7078
Practice Address - Fax:787-798-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEMPLOYER IDENTIFICATION NUMBER