MEDICARE: AMERICAN CARDIO LABS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1033424551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN CARDIO LABS

Provider Business Mailing Address
First Line	:	255 E RINCON ST STE 210
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-1368
Country	:	US
Telephone Number	:	951-776-7314
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 E RINCON ST STE 210
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-1368
Country	:	US
Telephone Number	:	951-776-7314
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DARIN SLACK
Credential	:	CCT
Telephone Number	:	951-776-7314

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	05/11/2016

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Directions to “AMERICAN CARDIO LABS ” Practice Location

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