Healthcare Provider Details

I. General information

NPI: 1275639478
Provider Name (Legal Business Name): THE CARDIOVASCULAR CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WILLISTON PARK PT STE 1000
LAKE MARY FL
32746-2172
US

IV. Provider business mailing address

910 WILLISTON PARK PT STE 1000
LAKE MARY FL
32746-2172
US

V. Phone/Fax

Practice location:
  • Phone: 407-833-8028
  • Fax: 407-833-8033
Mailing address:
  • Phone: 407-833-8028
  • Fax: 407-833-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS BILLETTE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 407-833-8028