Healthcare Provider Details

I. General information

NPI: 1972113546
Provider Name (Legal Business Name): PHOENICIAN CARDIAC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 W NORTHERN AVE # D-209
PHOENIX AZ
85021-9369
US

IV. Provider business mailing address

2228 W NORTHERN AVE STE B210
PHOENIX AZ
85021-9336
US

V. Phone/Fax

Practice location:
  • Phone: 480-444-7464
  • Fax: 480-355-1798
Mailing address:
  • Phone: 480-444-7464
  • Fax: 480-355-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PARAMVIR TULI
Title or Position: CEO/OWNER
Credential:
Phone: 480-323-0244