Healthcare Provider Details

I. General information

NPI: 1598782328
Provider Name (Legal Business Name): CARDIOFIT MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD STE 250
TORRANCE CA
90505-4774
US

IV. Provider business mailing address

23456 HAWTHORNE BLVD STE 250
TORRANCE CA
90505-4774
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-5577
  • Fax: 310-791-5575
Mailing address:
  • Phone: 310-791-5577
  • Fax: 310-791-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG59477
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG594477
License Number StateCA

VIII. Authorized Official

Name: DR. LEONARD J. SCUDERI
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 310-791-5577