Healthcare Provider Details

I. General information

NPI: 1316990609
Provider Name (Legal Business Name): LOS ANGELES CARDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E HIGHLAND AVE SUITE 424
SAN BERNARDINO CA
92404-3870
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 909-883-5315
  • Fax: 909-883-5399
Mailing address:
  • Phone: 213-477-0419
  • Fax: 213-250-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DANA R HUNT
Title or Position: CFO
Credential:
Phone: 213-977-7418