Provider Demographics
NPI:1710484399
Name:CHILDREN'S HEART CLINIC
Entity Type:Organization
Organization Name:CHILDREN'S HEART CLINIC
Other - Org Name:CHILDREN'S HEART CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-405-4012
Mailing Address - Street 1:12025 NEW DOMINION PKWY APT 307
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-6267
Mailing Address - Country:US
Mailing Address - Phone:571-405-4012
Mailing Address - Fax:
Practice Address - Street 1:411 N CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2061
Practice Address - Country:US
Practice Address - Phone:818-839-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1459862080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty