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General NPI Number Information
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NPI Number | 1609354117
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Entity Type | Organization
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Legal Business Name | HEARTCARE MOBILE DIAGNOSTICS
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 2160 E MELROSE ST # 101
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City | GILBERT
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State | AZ
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Zip | 85297-1132
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Country | US
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Telephone | 602-714-0961
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 E MELROSE ST # 101
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City | GILBERT
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State | AZ
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Zip | 85297-1132
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Country | US
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Telephone | 602-714-0961
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT ANDRES
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Credential |
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Telephone | 602-714-0961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0207X
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Taxonomy Name | Mobile Mammography Clinic/Center
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License Number | 000819-2018
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License Number State | AZ
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