Basic Information
| Provider Information | |||||||||
| NPI: | 1770865875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOS ANGELES CARDIOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | 703 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139770419 | ||||||||
| FaxNumber: | 2139770225 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139770419 | ||||||||
| FaxNumber: | 2139770225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2011 | ||||||||
| LastUpdateDate: | 08/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | HUNT | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2139777420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.