Provider Demographics
NPI:1598548406
Name:CENTRO CARDIOLOGICO Y TERAPIA ENDOVASCULAR
Entity Type:Organization
Organization Name:CENTRO CARDIOLOGICO Y TERAPIA ENDOVASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONK
Authorized Official - Suffix:
Authorized Official - Credentials:MGR
Authorized Official - Phone:440-534-0208
Mailing Address - Street 1:5764 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AV TERRANOVA 556
Practice Address - Street 2:PRADOS PROVIDENCIA
Practice Address - City:GUADALAJARA
Practice Address - State:JALISCO
Practice Address - Zip Code:49000
Practice Address - Country:MX
Practice Address - Phone:440-534-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital