Provider Demographics
NPI:1184029993
Name:CORAZON CARDIAC & VASCULAR INSTITUTE, PLLC
Entity Type:Organization
Organization Name:CORAZON CARDIAC & VASCULAR INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRIDHVI
Authorized Official - Middle Name:R
Authorized Official - Last Name:YELAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-786-9685
Mailing Address - Street 1:PO BOX 9028
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-9028
Mailing Address - Country:US
Mailing Address - Phone:480-786-9685
Mailing Address - Fax:
Practice Address - Street 1:116 N LINDSAY RD
Practice Address - Street 2:STE 7
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-9201
Practice Address - Country:US
Practice Address - Phone:480-786-9685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty