Basic Information
| Provider Information | |||||||||
| NPI: | 1922281336 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDIOLOGY HEALTHCARE OF SOUTH FLORIDA CORP | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7190 SW 87TH AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331732507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052703075 | ||||||||
| FaxNumber: | 3054126338 | ||||||||
| Practice Location | |||||||||
| Address1: | 7190 SW 87TH AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331732507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052703075 | ||||||||
| FaxNumber: | 3054126338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2007 | ||||||||
| LastUpdateDate: | 08/08/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DIEGO | ||||||||
| AuthorizedOfficialFirstName: | JOAQUIN | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3052703075 | ||||||||
| 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 | ME56696 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.