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General NPI Number Information
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NPI Number | 1194903542
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Entity Type | Organization
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Legal Business Name | PACIFIC CARDIOVASCULAR, P.S.
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 1901 S UNION AVE BLDG B SUITE 3001
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City | TACOMA
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State | WA
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Zip | 98405-1702
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Country | US
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Telephone | 253-572-4900
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Fax | 253-572-4645
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Provider Business Mailing Address
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Address Line | PO BOX 64809
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98464-0809
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Country | US
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Telephone | 253-572-4900
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Fax | 253-572-4645
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAJU PATEL
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Credential | D.O.
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Telephone | 253-572-4900
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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 | OP00001797
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License Number State | WA
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