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General NPI Number Information
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NPI Number | 1104484641
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Entity Type | Organization
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Legal Business Name | MIRAKEL HEART ARTERY AND VEIN CENTER PC
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 128 S MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4730
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Country | US
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Telephone | 323-726-9606
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Fax | 323-726-8566
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Provider Business Mailing Address
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Address Line | 128 S MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4730
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Country | US
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Telephone | 323-726-9606
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Fax | 323-726-8566
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | ERIKA RUIZ
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Credential |
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Telephone | 213-584-0534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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