Healthcare Provider Details

I. General information

NPI: 1154375343
Provider Name (Legal Business Name): SOUTHWEST DESERT CARDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE STE 300
PHOENIX AZ
85027-3254
US

IV. Provider business mailing address

PO BOX 5608
CAREFREE AZ
85377-5608
US

V. Phone/Fax

Practice location:
  • Phone: 623-879-6000
  • Fax: 623-516-2000
Mailing address:
  • Phone: 623-879-6000
  • Fax: 623-516-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN S RANIOLO
Title or Position: OWNER
Credential: D.O.
Phone: 623-879-6000