Healthcare Provider Details

I. General information

NPI: 1821325747
Provider Name (Legal Business Name): ARIZONA CARDIOVASCULAR CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10872 E RAINTREE DR
SCOTTSDALE AZ
85255-1800
US

IV. Provider business mailing address

PO BOX 20490
MESA AZ
85277-0490
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-1093
  • Fax: 480-985-0468
Mailing address:
  • Phone: 480-296-7646
  • Fax: 480-296-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KHALED ALBASHA
Title or Position: PRESIDIENT
Credential: MD
Phone: 480-296-7646