Healthcare Provider Details

I. General information

NPI: 1669634481
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 N 2ND ST SUITE 321
PHOENIX AZ
85020
US

IV. Provider business mailing address

PO BOX 98819
LAS VEGAS NV
89193
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-1789
  • Fax: 602-870-8431
Mailing address:
  • Phone: 602-494-3659
  • Fax: 602-867-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREI DAMIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 602-867-8644