Healthcare Provider Details

I. General information

NPI: 1023122843
Provider Name (Legal Business Name): CARDIOJOST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7529 E BROADWAY RD STE 101
MESA AZ
85208-2007
US

IV. Provider business mailing address

7529 E BROADWAY RD STE 101
MESA AZ
85208-2007
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-4343
  • Fax: 480-945-4350
Mailing address:
  • Phone: 480-945-4343
  • Fax: 480-945-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28064
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES M.T. JOST
Title or Position: CEO
Credential: MD
Phone: 480-945-4343