MEDICARE: HEART SQUAD INC

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	:	1750711214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART SQUAD INC

Provider Business Mailing Address
First Line	:	1601 N SEPULVEDA BLVD
Second Line	:	SUITE #216
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5111
Country	:	US
Telephone Number	:	310-939-7964
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 N SEPULVEDA BLVD # 216
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5111
Country	:	US
Telephone Number	:	310-939-7964
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT AMBROSE
Credential	:
Telephone Number	:	310-939-7654

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	03/19/2016

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Directions to “HEART SQUAD INC ” Practice Location

Language	Start Address	Practice Location

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