1063748002 NPI number — CARDIOLOGISTS LC

Table of content: ANGELA GRACE ROBLES LPC, LCDC (NPI 1043973001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063748002 NPI number — CARDIOLOGISTS LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLOGISTS LC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063748002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50302-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-364-7101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 10TH ST SE
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52403-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-364-7101
Provider Business Practice Location Address Fax Number:
319-363-1993
Provider Enumeration Date:
10/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AUNAN
Authorized Official First Name:
MILTON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR/OFFICER
Authorized Official Telephone Number:
319-369-7094

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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