Provider Demographics
NPI:1841387438
Name:CARDIOVASCULAR TECHNOLOGY & ASSOCIATES SOUTHERN CALIFORNIA INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR TECHNOLOGY & ASSOCIATES SOUTHERN CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:ESPIRITU
Authorized Official - Last Name:ROSETE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:949-347-7244
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:EL TORO RD
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92609-0664
Mailing Address - Country:US
Mailing Address - Phone:949-347-7244
Mailing Address - Fax:949-365-0708
Practice Address - Street 1:26611 LA QUILLA LN
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3926
Practice Address - Country:US
Practice Address - Phone:949-347-7244
Practice Address - Fax:949-365-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG200Medicare ID - Type Unspecified