=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780127266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARIZONA CARDIOVASCULAR CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2016
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1847 E SOUTHERN AVE STE 4
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-5881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-878-4077
-----------------------------------------------------
Fax | 480-498-5269
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 45200
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85064-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-878-4077
-----------------------------------------------------
Fax | 480-498-5269
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERVENTIONAL CARDIOLOGY
-----------------------------------------------------
Name | DR. GHASSAN FRAIJ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 480-878-4077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 48310
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------