Provider Demographics
NPI:1164619847
Name:HEART SQUAD, INC.
Entity Type:Organization
Organization Name:HEART SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-939-7654
Mailing Address - Street 1:575 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2211
Mailing Address - Country:US
Mailing Address - Phone:310-939-7654
Mailing Address - Fax:310-546-2921
Practice Address - Street 1:575 29TH ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2211
Practice Address - Country:US
Practice Address - Phone:310-939-7654
Practice Address - Fax:310-546-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty