Provider Demographics
NPI:1629748520
Name:CENTRO CARDIOVASCULAR CHAPALITA
Entity Type:Organization
Organization Name:CENTRO CARDIOVASCULAR CHAPALITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGOVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MGR
Authorized Official - Phone:333-878-1400
Mailing Address - Street 1:1441 WOODMONT LN NW # 1398
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AV NINO OBRERO 1666
Practice Address - Street 2:COL CHAPALITA
Practice Address - City:ZAPOPAN
Practice Address - State:JALISCO
Practice Address - Zip Code:45040
Practice Address - Country:MX
Practice Address - Phone:333-878-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HSM721001KQ2OtherSTATE