Provider Demographics
NPI:1710949334
Name:CARDIOVASCULAR CONSULTANTS P A
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFF MGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA LUZ
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-726-0112
Mailing Address - Street 1:7421 N UNIVERSITY DR
Mailing Address - Street 2:STE 112
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2977
Mailing Address - Country:US
Mailing Address - Phone:954-726-0112
Mailing Address - Fax:954-726-9561
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:STE112
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-726-0112
Practice Address - Fax:954-726-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045573207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252528300Medicaid
FL40175Medicare ID - Type Unspecified