Basic Information
| Provider Information | |||||||||
| NPI: | 1407809791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOS ANGELES CARDIOLOGY ASSOCIATES | ||||||||
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| OtherOrganizationName: | LOS ANGELES CARDIOLOGY ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 703 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139770419 | ||||||||
| FaxNumber: | 2132509416 | ||||||||
| Practice Location | |||||||||
| Address1: | 685 N 13TH AVE | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099493977 | ||||||||
| FaxNumber: | 9099203054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 12/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUNT | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2139777418 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | GR0025121 | 05 | CA | MEDICAID |