Healthcare Provider Details

I. General information

NPI: 1023784394
Provider Name (Legal Business Name): QUEVEDO CARDIOVASCULAR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 CENTRAL AVE STE 203
PHILADELPHIA PA
19111-2432
US

IV. Provider business mailing address

600 KENNERLY RD
SPRINGFIELD PA
19064-2026
US

V. Phone/Fax

Practice location:
  • Phone: 215-289-4434
  • Fax: 215-289-7442
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY QUEVEDO DIAZ
Title or Position: OWNER
Credential: MD
Phone: 305-505-8347