Basic Information
| Provider Information | |||||||||
| NPI: | 1669850236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIAC CENTER OF AMERICA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10722 ARROW RTE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917304808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094842865 | ||||||||
| FaxNumber: | 9099416974 | ||||||||
| Practice Location | |||||||||
| Address1: | 10722 ARROW RTE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917304808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094842865 | ||||||||
| FaxNumber: | 9099416974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 04/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | ARUNASALAM | ||||||||
| AuthorizedOfficialFirstName: | SIVA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7602412270 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G66022 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.