1932625779 NPI number — ARIZONA HEART 360, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932625779 NPI number — ARIZONA HEART 360, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA HEART 360, P.C.
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:
1932625779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13208 N 13TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85022-4932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-434-1956
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20045 N 19TH AVE STE 165
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85027-4254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-404-3115
Provider Business Practice Location Address Fax Number:
623-215-7670
Provider Enumeration Date:
08/14/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DESAI
Authorized Official First Name:
SARIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
CARDIOLOGIST
Authorized Official Telephone Number:
818-434-1956

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  0005794 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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