Provider Demographics
NPI:1740946128
Name:PACIFIC CARDIOVASCULAR CENTER, LLC
Entity type:Organization
Organization Name:PACIFIC CARDIOVASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAGHUNANDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-707-4525
Mailing Address - Street 1:550 HAWTHORNE AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5206
Mailing Address - Country:US
Mailing Address - Phone:971-707-4525
Mailing Address - Fax:
Practice Address - Street 1:550 HAWTHORNE AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5206
Practice Address - Country:US
Practice Address - Phone:971-707-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical