Provider Demographics
NPI:1669856795
Name:CARDIO CARE PRACTICE LLC
Entity Type:Organization
Organization Name:CARDIO CARE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVAHED SHARIAT PANAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD/ PHD
Authorized Official - Phone:949-400-0091
Mailing Address - Street 1:6119 NORTH PINCHOT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750
Mailing Address - Country:US
Mailing Address - Phone:520-303-4572
Mailing Address - Fax:
Practice Address - Street 1:6119 N PINCHOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1297
Practice Address - Country:US
Practice Address - Phone:520-303-4572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZA35065302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization