=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144693755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART & VASCULAR HEALTH, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2015
-----------------------------------------------------
Last Update Date | 11/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21321 E OCOTILLO RD #126
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-5996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-738-3220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21321 E OCOTILLO RD #126
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-5996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-738-3220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. ERNESTO RAMOS CRUZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 480-738-3220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 26508
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------