Healthcare Provider Details

I. General information

NPI: 1851552665
Provider Name (Legal Business Name): COMPLETE CARDIOLOGY CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 W GRANADA BLVD FL 2
ORMOND BEACH FL
32174-5915
US

IV. Provider business mailing address

PO BOX 291427
PORT ORANGE FL
32129-1427
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-1023
  • Fax: 386-263-2996
Mailing address:
  • Phone: 386-672-1023
  • Fax: 386-263-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME112914
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME101341
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberME72993
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME72993
License Number StateFL

VIII. Authorized Official

Name: HUIJIAN JAMES WANG
Title or Position: OWNER
Credential: MD
Phone: 386-672-1023