Healthcare Provider Details

I. General information

NPI: 1114515244
Provider Name (Legal Business Name): ECS CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENDA DR
RIVERVIEW FL
33578-5835
US

IV. Provider business mailing address

10010 KENDA DR
RIVERVIEW FL
33578-5835
US

V. Phone/Fax

Practice location:
  • Phone: 727-365-0803
  • Fax:
Mailing address:
  • Phone: 727-365-0803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON S OKUHARA
Title or Position: PHYSICIAN AT ECS CARDIOLOGY
Credential: DO
Phone: 727-365-0803