Healthcare Provider Details

I. General information

NPI: 1689892051
Provider Name (Legal Business Name): LOS ANGELES CARDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE STE 203
RIVERSIDE CA
92501-4027
US

IV. Provider business mailing address

1245 WILSHIRE BLVD STE 703
LOS ANGELES CA
90017-4807
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-3600
  • Fax: 951-686-1162
Mailing address:
  • Phone: 213-977-7422
  • Fax: 213-250-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DANA HUNT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 213-977-7422