Healthcare Provider Details

I. General information

NPI: 1427307008
Provider Name (Legal Business Name): DANIEL LEONARD HLAVACEK CCDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3967 EAST HERRERA DRIVE
PHOENIX AZ
85050
US

IV. Provider business mailing address

3967 EAST HERRERA DRIVE
PHOENIX AZ
85050
US

V. Phone/Fax

Practice location:
  • Phone: 602-321-7680
  • Fax: 480-704-3471
Mailing address:
  • Phone: 602-321-7680
  • Fax: 480-704-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: