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General NPI Number Information
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NPI Number | 1184619025
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Entity Type | Organization
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Legal Business Name | SIERRA NEVADA CARDIOLOGY ASSOCIATES CATHETERIZATION LABORATORY
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 75 PRINGLE WAY G16
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City | RENO
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State | NV
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Zip | 89502-1464
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Country | US
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Telephone | 775-327-8484
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Fax | 775-327-8480
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Provider Business Mailing Address
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Address Line | 75 PRINGLE WAY G16
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City | RENO
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State | NV
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Zip | 89502-1464
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Country | US
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Telephone | 775-327-8484
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Fax | 775-327-8480
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN CARROLL
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Credential |
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Telephone | 520-886-7889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 1604300001
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License Number State | NV
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