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General NPI Number Information
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NPI Number | 1134301104
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Entity Type | Organization
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Legal Business Name | FLORIDA CARDIOVASCULAR DIAGNOSTIC SERVICES LLC
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 605 N WASHINGTON AVE # 100
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City | TITUSVILLE
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State | FL
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Zip | 32796-2107
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Country | US
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Telephone | 321-228-9822
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Fax |
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Provider Business Mailing Address
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Address Line | 605 N WASHINGTON AVE # 100
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City | TITUSVILLE
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State | FL
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Zip | 32796-2107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NARESH V MODY
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Credential | MD
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Telephone | 321-383-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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