Basic Information
| Provider Information | |||||||||
| NPI: | 1548281876 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRADENTON CARDIOLOGY CENTER P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 MANATEE AVE W | ||||||||
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| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342058805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417482277 | ||||||||
| FaxNumber: | 9417484244 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 MANATEE AVE W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342058805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417482277 | ||||||||
| FaxNumber: | 9417484244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | MONTALVO | ||||||||
| AuthorizedOfficialFirstName: | ALBERTO | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9417482277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.