Basic Information
| Provider Information | |||||||||
| NPI: | 1922146661 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTELOPE VALLEY CARDIOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43723 20TH ST. WEST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616744222 | ||||||||
| FaxNumber: | 6616744220 | ||||||||
| Practice Location | |||||||||
| Address1: | 43723 20TH ST. WEST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616744222 | ||||||||
| FaxNumber: | 6616744220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | KADAMBI | ||||||||
| AuthorizedOfficialFirstName: | PRAMOD | ||||||||
| AuthorizedOfficialMiddleName: | V. | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6616744222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.