Provider Demographics
NPI:1558329813
Name:CARDIO VASCULAR PLUS INC
Entity Type:Organization
Organization Name:CARDIO VASCULAR PLUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DAGOSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-789-4356
Mailing Address - Street 1:18700 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9446
Mailing Address - Country:US
Mailing Address - Phone:951-789-4356
Mailing Address - Fax:951-789-4294
Practice Address - Street 1:7893 MISSION GROVE PKWY S
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5087
Practice Address - Country:US
Practice Address - Phone:951-789-4356
Practice Address - Fax:951-789-4294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D1030088291U00000X
CACLR332061291U00000X
CASR EH 52034861331L00000X
CASR EH 52-034861332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No331L00000XSuppliersBlood Bank
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment