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General NPI Number Information
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NPI Number | 1922241215
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Entity Type | Organization
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Legal Business Name | SAN BERNARDINO CARDIO CARE
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 05/14/2010
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Provider Practice Location Address
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Address Line | 5231 ONAKNOLL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90043-1041
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Country | US
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Telephone | 323-793-9183
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Fax |
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Provider Business Mailing Address
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Address Line | 5231 ONAKNOLL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90043-1041
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Country | US
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Telephone | 323-294-8123
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JACQUELYN THOMPSON
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Credential |
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Telephone | 323-294-8123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | CA
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