Provider Demographics
NPI:1326356494
Name:CARDIOGENT, INC.
Entity Type:Organization
Organization Name:CARDIOGENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANEI-FARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-749-6628
Mailing Address - Street 1:PO BOX 6139
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-8555
Mailing Address - Country:US
Mailing Address - Phone:530-749-6628
Mailing Address - Fax:530-749-6627
Practice Address - Street 1:414 G ST
Practice Address - Street 2:STE 108
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5663
Practice Address - Country:US
Practice Address - Phone:530-749-6628
Practice Address - Fax:530-749-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112750207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty