Provider Demographics
NPI:1407809791
Name:LOS ANGELES CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:LOS ANGELES CARDIOLOGY ASSOCIATES
Other - Org Name:LOS ANGELES CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-977-7418
Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4807
Mailing Address - Country:US
Mailing Address - Phone:213-977-0419
Mailing Address - Fax:213-250-9416
Practice Address - Street 1:685 N 13TH AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4963
Practice Address - Country:US
Practice Address - Phone:909-949-3977
Practice Address - Fax:909-920-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0025121Medicaid
CAGR0025121Medicaid