Provider Demographics
NPI:1154504363
Name:3D CARDIO DIAGNOSTIC CENTER PA
Entity Type:Organization
Organization Name:3D CARDIO DIAGNOSTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-659-2502
Mailing Address - Street 1:104 N EVERS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3300
Mailing Address - Country:US
Mailing Address - Phone:813-659-2502
Mailing Address - Fax:
Practice Address - Street 1:104 N EVERS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3300
Practice Address - Country:US
Practice Address - Phone:813-659-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty