Provider Demographics
NPI:1558425298
Name:CARDIOLOGY CENTER OF TAMPA P A
Entity Type:Organization
Organization Name:CARDIOLOGY CENTER OF TAMPA P A
Other - Org Name:CANEDO & GARCIA MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:I
Authorized Official - Last Name:CANDEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-971-2600
Mailing Address - Street 1:13701 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4647
Mailing Address - Country:US
Mailing Address - Phone:813-971-2600
Mailing Address - Fax:813-979-1574
Practice Address - Street 1:13701 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4647
Practice Address - Country:US
Practice Address - Phone:813-971-2600
Practice Address - Fax:813-979-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72663Medicare PIN