Provider Demographics
NPI:1073832994
Name:HEART CHECK LOS ANGELES LLC
Entity Type:Organization
Organization Name:HEART CHECK LOS ANGELES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-489-6305
Mailing Address - Street 1:11859 WILSHIRE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6600
Mailing Address - Country:US
Mailing Address - Phone:310-479-2211
Mailing Address - Fax:
Practice Address - Street 1:11859 WILSHIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6600
Practice Address - Country:US
Practice Address - Phone:310-479-2211
Practice Address - Fax:310-479-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87133261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center