Healthcare Provider Details

I. General information

NPI: 1689878241
Provider Name (Legal Business Name): CEDARS HEART CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 N PEART RD BUILDING B, SUITE 4
CASA GRANDE AZ
85122-2495
US

IV. Provider business mailing address

1968 N PEART RD BUILDING B, SUITE 4
CASA GRANDE AZ
85122-2495
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-6661
  • Fax: 520-836-6663
Mailing address:
  • Phone: 520-836-6661
  • Fax: 520-836-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number29317
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ZIAD ELGHOUL
Title or Position: CEO
Credential: MD
Phone: 480-917-5900