# CENTRO CARDIONUCLEAR DE PONCE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205090487
- **Authorized official:** FARES A CID MANSUR MD (PRESIDENT)
- **Authorized official phone:** (787) 812-1210

## Contact information

- **Practice address:** AVE TITO CASTRO 909, TORRE MEDICA SAN LUCAS OFICINA 509, PONCE, PR 00716
- **Practice address phone:** (787) 812-1210
- **Practice address fax:** (787) 812-1211
- **Mailing address:** PMB 383609, AVE TITO CASTRO SUITE 102, PONCE, PR 00716
- **Mailing address phone:** (787) 812-1210
- **Mailing address fax:** (787) 812-1211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207UN0901X | Nuclear Cardiology Physician | — | NULL | Yes |
| 207UN0901X | Nuclear Cardiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/16/2008
- **Last updated:** 08/05/2010