Provider Demographics
NPI:1891938155
Name:CIRCLE CITY EKG READING PANEL,INC
Entity Type:Organization
Organization Name:CIRCLE CITY EKG READING PANEL,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN,DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSCOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-734-4880
Mailing Address - Street 1:2250 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2534
Mailing Address - Country:US
Mailing Address - Phone:951-734-4880
Mailing Address - Fax:951-735-3566
Practice Address - Street 1:2250 S MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2536
Practice Address - Country:US
Practice Address - Phone:951-734-4880
Practice Address - Fax:951-735-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty