Healthcare Provider Details

I. General information

NPI: 1285647966
Provider Name (Legal Business Name): VICTORIA CARDIOVASCULAR IMAGING LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SAN ANTONIO ST STE 104W
VICTORIA TX
77901-6040
US

IV. Provider business mailing address

601 E SAN ANTONIO ST STE 104W
VICTORIA TX
77901-6040
US

V. Phone/Fax

Practice location:
  • Phone: 361-788-6627
  • Fax: 361-580-2201
Mailing address:
  • Phone: 361-788-6628
  • Fax: 361-788-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HARISH CHANDNA
Title or Position: CO DIRECTOR
Credential: MD
Phone: 361-788-6628