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General NPI Number Information
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NPI Number | 1558557918
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR CARDIOVASCULAR DISEASE PA
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 2301 NW 87TH AVE SUITE 502
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City | DORAL
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State | FL
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Zip | 33172-2403
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Country | US
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Telephone | 305-558-3300
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Fax | 305-558-5775
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Provider Business Mailing Address
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Address Line | 2301 NW 87TH AVE SUITE 502
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City | DORAL
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State | FL
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Zip | 33172-2403
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Country | US
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Telephone | 305-558-3300
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Fax | 305-558-5775
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOUIS ADALBERTO FERNANDEZ
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Credential | M.D., FACC,FACP
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Telephone | 305-558-3300
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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 | 53375
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License Number State | FL
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