Provider Demographics
NPI:1083678486
Name:CONSULTING INTERVENTIONAL CARDIOLOGY LLC
Entity type:Organization
Organization Name:CONSULTING INTERVENTIONAL CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-386-6855
Mailing Address - Street 1:PO BOX 4398
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-4398
Mailing Address - Country:US
Mailing Address - Phone:209-575-4575
Mailing Address - Fax:209-575-4598
Practice Address - Street 1:112 S WATER ST
Practice Address - Street 2:#108
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-2312
Practice Address - Country:US
Practice Address - Phone:702-386-6855
Practice Address - Fax:209-575-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6379207RI0011X
AZ17530207RI0011X
NV5498207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002858Medicaid
AA9643619OtherDEA
B97012Medicare UPIN
NV002002858Medicaid