Healthcare Provider Details

I. General information

NPI: 1740901396
Provider Name (Legal Business Name): CARDIAC SURGERY CENTER OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20199 N 67TH AVE
GLENDALE AZ
85308-7001
US

IV. Provider business mailing address

20199 N 67TH AVE
GLENDALE AZ
85308-7001
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-9002
  • Fax: 833-464-3265
Mailing address:
  • Phone: 623-561-9002
  • Fax: 833-464-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAHUL MALHOTRA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 480-765-2800