Provider Demographics
NPI:1164653861
Name:ON-SITE CARDIOVASCULAR IMAGING LLC
Entity Type:Organization
Organization Name:ON-SITE CARDIOVASCULAR IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-836-7090
Mailing Address - Street 1:4923 RANCHERS RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4387
Mailing Address - Country:US
Mailing Address - Phone:210-373-3829
Mailing Address - Fax:
Practice Address - Street 1:8026 VANTAGE DR
Practice Address - Street 2:SUITE 130 G
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4733
Practice Address - Country:US
Practice Address - Phone:210-373-3829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42353246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty