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General NPI Number Information
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NPI Number | 1801555784
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Entity Type | Organization
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Legal Business Name | 360 CARDIAC CARE PC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 4375 BOOTH CALLOWAY RD STE 210
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-8362
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Country | US
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Telephone | 817-678-5988
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Fax | 817-693-1037
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Provider Business Mailing Address
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Address Line | 517 BOULDER DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-3719
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Country | US
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Telephone | 917-334-7534
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANJAYANTH CHAMAKURA
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Credential | MD
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Telephone | 917-334-7534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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