=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568593234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOCURA CAPITAL WEST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26552 SADDLEHORN LN
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-433-4403
-----------------------------------------------------
Fax | 866-470-5931
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26552 SADDLEHORN LN
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-433-4403
-----------------------------------------------------
Fax | 866-470-5931
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | PETER KEMPF
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 949-433-4403
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number | 64177
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------