=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194854547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIO SCAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2007
-----------------------------------------------------
Last Update Date | 02/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8026 VANTAGE DR STE 224
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-979-0563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8026 VANTAGE DR STE 224
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-979-0563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | MR. BENJAMIN VELEZ
-----------------------------------------------------
Credential | RDCS
-----------------------------------------------------
Telephone | 210-710-5742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------