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General NPI Number Information
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NPI Number | 1326169996
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Entity Type | Organization
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Legal Business Name | AMERICAN CARDIO LABS
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 17 ELMHURST ST
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City | LADERA RANCH
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State | CA
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Zip | 92694-0850
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Country | US
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Telephone | 800-200-4225
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Fax |
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Provider Business Mailing Address
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Address Line | 27702 CROWN VALLEY PKWY # D4-150
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City | LADERA RANCH
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State | CA
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Zip | 92694-0608
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Country | US
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Telephone | 800-200-4225
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BRAD J. ROELOFS
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Credential | CCT
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Telephone | 800-200-4225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | TG033
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License Number State | CA
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