Healthcare Provider Details

I. General information

NPI: 1790919801
Provider Name (Legal Business Name): GALLUP CARDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 E AZTEC AVE
GALLUP NM
87301-4804
US

IV. Provider business mailing address

2028 E AZTEC AVE
GALLUP NM
87301-4804
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-2208
  • Fax: 505-863-2236
Mailing address:
  • Phone: 505-863-2208
  • Fax: 505-863-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number98-177
License Number StateNM

VIII. Authorized Official

Name: ANANDAN SWAMINATHAN
Title or Position: OWNER
Credential: MD
Phone: 505-979-0560