=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275701740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOLOGY CONSULTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2008
-----------------------------------------------------
Last Update Date | 08/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6787 SW WAMPANOAG DR
-----------------------------------------------------
City | TUALATIN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-913-7206
-----------------------------------------------------
Fax | 503-344-6536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3423 ROYCE WAY
-----------------------------------------------------
City | LAKE OSWEGO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97034-7372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-913-7206
-----------------------------------------------------
Fax | 503-638-6748
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANIELA SAMOIL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 503-913-7206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | MD20595
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------