Basic Information
| Provider Information | |||||||||
| NPI: | 1124408083 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDIO ONCALL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 713 SANTA ANA AVE | ||||||||
| Address2: | |||||||||
| City: | RANCHO VIEJO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785759747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566985613 | ||||||||
| FaxNumber: | 9566984953 | ||||||||
| Practice Location | |||||||||
| Address1: | 713 SANTA ANA AVE | ||||||||
| Address2: | |||||||||
| City: | RANCHO VIEJO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785759747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566985613 | ||||||||
| FaxNumber: | 9566984953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2015 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALFAYOUMI | ||||||||
| AuthorizedOfficialFirstName: | FADI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9566985613 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | M3448 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.