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General NPI Number Information
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NPI Number | 1861681355
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Entity Type | Organization
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Legal Business Name | ST JUDE CARDIOTHORACIC SURGEONS
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 301 W BASTANCHURY RD SUITE 195
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City | FULLERTON
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State | CA
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Zip | 92835-3419
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Country | US
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Telephone | 714-446-8866
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Fax | 714-997-1187
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Provider Business Mailing Address
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Address Line | 1310 W STEWART DR SUITE 503
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City | ORANGE
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State | CA
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Zip | 92868-3854
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Country | US
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Telephone | 714-997-2224
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Fax | 714-997-1187
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | RICHARD N GATES
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Credential | MD
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Telephone | 714-997-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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