Healthcare Provider Details

I. General information

NPI: 1194072173
Provider Name (Legal Business Name): CARDIOLOGY CONSULTANTS OF THE SOUTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 214
HIALEAH FL
33013-3850
US

IV. Provider business mailing address

777 E 25TH ST STE 214
HIALEAH FL
33013-3850
US

V. Phone/Fax

Practice location:
  • Phone: 305-836-1997
  • Fax:
Mailing address:
  • Phone: 305-836-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE E ESCALANTE
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 305-836-1997