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General NPI Number Information
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NPI Number | 1740622877
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Entity Type | Organization
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Legal Business Name | SECURECARDIO, LLC
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location 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 | 949-422-7536
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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 |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRAD ROELOFS
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Credential |
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Telephone | 949-422-7536
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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 |
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License Number State |
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