Provider Demographics
NPI:1104484641
Name:MIRAKEL HEART ARTERY AND VEIN CENTER PC
Entity type:Organization
Organization Name:MIRAKEL HEART ARTERY AND VEIN CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-391-5998
Mailing Address - Street 1:101 E BEVERLY BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4317
Mailing Address - Country:US
Mailing Address - Phone:323-726-9606
Mailing Address - Fax:323-727-1036
Practice Address - Street 1:101 E BEVERLY BLVD STE 408
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4317
Practice Address - Country:US
Practice Address - Phone:323-726-9606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty