Healthcare Provider Details

I. General information

NPI: 1407058480
Provider Name (Legal Business Name): HEARTPUMPER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 OUTLOOK DR
MELBOURNE FL
32940-2345
US

IV. Provider business mailing address

5302 OUTLOOK DR
MELBOURNE FL
32940-2345
US

V. Phone/Fax

Practice location:
  • Phone: 321-480-3008
  • Fax:
Mailing address:
  • Phone: 321-480-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code246QH0401X
TaxonomyHemapheresis Practitioner
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License Number
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2472B0301X
TaxonomyBiomedical Engineering Technician
License Number
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code2472V0600X
TaxonomyVeterinary Technician
License Number
License Number StateFL

VIII. Authorized Official

Name: PROF. RICHARD ANTHONY RALEY
Title or Position: CEO, SR. CLINICAL PERFUSIONIST
Credential: MPS, CCT, CCP
Phone: 321-480-3008