Healthcare Provider Details

I. General information

NPI: 1790540821
Provider Name (Legal Business Name): CARDIAC MOBILE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 SILVER EDGE ST
N LAS VEGAS NV
89031-3802
US

IV. Provider business mailing address

6220 SILVER EDGE ST
N LAS VEGAS NV
89031-3802
US

V. Phone/Fax

Practice location:
  • Phone: 702-612-0077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN JOSEPH YANDOLINO
Title or Position: OWNER
Credential:
Phone: 702-612-0077