Basic Information
| Provider Information | |||||||||
| NPI: | 1124114665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDIOVASCULAR ASSOCIATES OF MESA-GILBERT | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6335 E MAIN ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852058965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806415400 | ||||||||
| FaxNumber: | 4802184705 | ||||||||
| Practice Location | |||||||||
| Address1: | 6335 E MAIN ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852058965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806415400 | ||||||||
| FaxNumber: | 4802184705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TELLES | ||||||||
| AuthorizedOfficialFirstName: | DEB | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4806415400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.