Healthcare Provider Details

I. General information

NPI: 1386289288
Provider Name (Legal Business Name): VANGUARD CATHETERIZATION LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 DAVIE BLVD
FORT LAUDERDALE FL
33312-2758
US

IV. Provider business mailing address

603 N FLAMINGO RD STE 150
PEMBROKE PINES FL
33028-1022
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-6660
  • Fax:
Mailing address:
  • Phone: 954-436-6660
  • Fax: 954-436-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIAN AHMED HASAN
Title or Position: MD OWNER
Credential: MD
Phone: 954-854-6667