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General NPI Number Information
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NPI Number | 1487024758
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Entity Type | Organization
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Legal Business Name | MYO CARDIOVASCULAR CLINIC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 1790 GRANDE BLVD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-1726
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Country | US
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Telephone | 505-892-0402
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Fax | 505-892-5544
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Provider Business Mailing Address
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Address Line | 1790 GRANDE BLVD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-1726
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Country | US
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Telephone | 505-892-0402
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Fax | 505-892-5544
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Authorized Official
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Title or Position | MD
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Name | DR. ARMIN FOGHI
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Credential | MD
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Telephone | 505-892-0402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD2005-0713
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License Number State | NM
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