Healthcare Provider Details

I. General information

NPI: 1982603908
Provider Name (Legal Business Name): SUN CITY CARDIOLOGY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27830 BRADLEY RD
SUN CITY CA
92586-2201
US

IV. Provider business mailing address

27830 BRADLEY RD
SUN CITY CA
92586-2201
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-3888
  • Fax: 951-672-3758
Mailing address:
  • Phone: 951-672-3888
  • Fax: 951-672-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA49209
License Number StateCA

VIII. Authorized Official

Name: BHOODEV TIWARI
Title or Position: CEO
Credential: MD
Phone: 951-672-3888