Provider Demographics
NPI:1104859180
Name:CARDIAC & THORACIC SURGERY
Entity Type:Organization
Organization Name:CARDIAC & THORACIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:CASTRO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-266-5100
Mailing Address - Street 1:3219 E CAMELBACK RD
Mailing Address - Street 2:#833
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2307
Mailing Address - Country:US
Mailing Address - Phone:602-266-5100
Mailing Address - Fax:602-266-7100
Practice Address - Street 1:5333 N 7TH ST
Practice Address - Street 2:SUITE B219
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2821
Practice Address - Country:US
Practice Address - Phone:602-266-5100
Practice Address - Fax:602-266-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12521208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ29874Medicare PIN
AZD36929Medicare UPIN