Provider Demographics
NPI:1568593234
Name:CARDIOCURA CAPITAL WEST LLC
Entity Type:Organization
Organization Name:CARDIOCURA CAPITAL WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPF
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:949-433-4403
Mailing Address - Street 1:26552 SADDLEHORN LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5733
Mailing Address - Country:US
Mailing Address - Phone:949-433-4403
Mailing Address - Fax:866-470-5931
Practice Address - Street 1:26552 SADDLEHORN LN
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5733
Practice Address - Country:US
Practice Address - Phone:949-433-4403
Practice Address - Fax:866-470-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64177261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATP134Medicare ID - Type Unspecified